The No Surprises Act (“NSA”) passed in the final days of 2020 as part of the Consolidated Appropriates Act, 2021 to create a federal solution to the problem of “surprise billing.” Most provisions of the NSA took effect on January 1, 2022. In this article, we provide a final “checklist” for providers and facilities to take inventory of their NSA compliance and operational measures as we dive into the new year.
No Surprises Act Disclosures. Certain providersii and facilitiesiv must notify patients of their rights under the NSA on a public website, and by providing to patients in a one-page written document, disclosures that include: (1) the requirements and prohibitions applicable to the provider or facility under the NSA and its implementing regulations; (2) information regarding any state balance billing laws;v and (3) information about how to contact state and federal agencies if the patient believes the provider or facility has violated the NSA.vi
Implement the Notice and Consent Process. The NSA does not apply to some out-of-network services when the patient is given notice and consents to the out of network care. Providers should develop systems to identify those encounters eligible for the notice and consent process and implement a procedure for giving notice and obtaining consent. vii
Prepare to Engage in the Independent Dispute Resolution (“IDR”) Process for Reimbursement Disputes. Health plans and issuers must reimburse providers and facilities directly for...
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