By: Cristina N. Hyde, JD

Last week, the United States Departments of Labor, Health and Human Services, and the Treasury released the latest installment in a series of final rules concerning the implementation of the No Surprises Act (the “Act”).   The Act provides patients with federal protections against balance billing; specifically requiring private health insurance companies to cover certain out-of-network bills and prohibiting providers from billing patients more than they would have to pay for in-network care.  You can read more about several key provisions in our previous blog post,”No Surprises Act: What Providers Should Know About the New Patient Protection Legislation.

Last week’s final rules specifically concern the arbitration process implementing the Act.  They  update the arbitration process for settling out-of-network billing disputes and emphasize transparency related to the medical claims payment process.  The new rules are intended to promote meaningful and open negations surrounding plans, issuers and the type of information submitted to independent entities related to claim disputes.  As such, the new rules not only instruct Independent Dispute Resolution entities on how to make payment determinations, but also provide specific instruction on the type of information to be included in a written decision.

Additional information, relating to the Act and all recent implementing regulations can be found both on the United States Department of Labor website and on the United States Centers for Medicare & Medicaid website.

If you have questions about the No Surprises Act, its implementing regulations, and how it affects you or your health care practice, Contact Us.