Summary of the No Surprises Act
The No Surprises Act (NSA), which took effect on Jan. 1, 2022, establishes federal protections intended to prevent commercially insured patients from receiving surprise medical bills from out of network providers, in both emergency and non-emergency settings. Specifically, the law applies to out-of-network providers and facilities delivering emergency care and out-of-network providers delivering emergency and nonemergency care at in-network facilities. The law also protects patients from surprise medical bills from out-of-network air ambulance services. The NSA prohibits balance billing for most emergency and some non-emergency services, and patients can’t be charged more than the in-network cost-sharing amount for these services. The NSA also requires that health care providers and facilities provide patients with an easy-to-understand notice explaining the applicable billing protections, the requirement to obtain the patient’s written consent to waive these protections, and how to report suspected violations by a provider or facility. In addition to several other provisions, the NSA also establishes an independent dispute resolution process by which providers and health plans can resolve out-of-network reimbursement disputes. For uninsured and self-pay patients, the NSA requires healthcare providers to furnish these patients with a good faith estimate of the total out-of-pocket costs for services upon request, or within a specific timeframe after an appointment is scheduled
For more information on the No Surprises Act, please review the information linked below:
AMA RESOURCES
AMA Summary of No Surprises Act Final Rule
AMA NSA Toolkit – Preparing for Implementation of the No Surprises Act
AMA NSA Toolkit – Independent Dispute Resolution (IDR) Process
CMS RESOURCES
Federal Independent Dispute Resolution Process Status Update – August 19, 2022
Common Mistakes and Helpful Tips for Parties Initiating an IDR Dispute
Model Notice and Consent Templates
CMS FAQs for Providers About the No Surprises Rules
FAQs – Good Faith Estimates (GFE) for Uninsured (or Self-Pay) Individuals: Part 1, Part 2, Part 3 and Part 4
WEBINARS
AMA Advocacy Insights webinar series: Implementing the No Surprises Act
AMA Advocacy Insights webinar series: Out-of-network payment process under the No Surprises Act
NEWS
KMA Joins PAI Amicus Brief on No Surprises Act – Kentucky Medical Association (kyma.org)
Final Rules on Surprise Billing Effective October 25
Still have questions? Visit CMS.gov/nosurprises or call the CMS No Surprises Act Help Desk at 1-800-985-3059 for more information.
