Resources for Physicians Navigating the No Surprises Act

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

2021 AMA NSA Provisions Guide

AMA NSA Toolkit – Preparing for Implementation of the No Surprises Act

AMA NSA Toolkit – Independent Dispute Resolution (IDR) Process

CMS RESOURCES

CMS Final Rule FAQs

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 and Part 2

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

KMA NSA Webinar

NEWS

KMA Joins PAI Amicus Brief on No Surprises Act – Kentucky Medical Association (kyma.org)

Still have questions? Visit CMS.gov/nosurprises or call the CMS No Surprises Act Help Desk at 1-800-985-3059 for more information.