No Surprises Act

The No Surprises Act (NSA) prohibits balance billing insured patients who receive emergency or non-emergency services from out-of-network providers at in-network facilities for amounts greater than the patient’s in-network cost-sharing requirement for such services.  The NSA also establishes a payment dispute resolution process and requirements to provide good faith estimates to uninsured or self-pay patients.  (Note: This rule applies to private pay patients because Medicare and Medicaid already have protections against surprise billing.)

Ending Surprise Medical Bills - This CMS page includes fact sheets, summaries, and resources for providers and patients.  Below we highlight some key guidance related to dispute resolution:

• Good Faith Estimates and Dispute Resolution for Providers and Facilities
• Uninsured or Self-Pay Individuals
• When a patient starts payment dispute regulation
• Administrative Fees

AMA Surprise Billing Toolkit - This toolkit can help practices understand and comply with the No Surprises Act, including responsibilities for preparing Good Faith Estimates for self-pay and uninsured patients.

Health plans also have obligations under this rule, particularly with respect to keeping provider directories current.  CAQH offers a 2-page summary of those requirements.