December 16, 2021
The federal No SurprisesAct takes effect January 1, 2022, bringing new balance billing requirements forhealth plans and providers. Here’s a brief overview to help you understand thebalance billing provisions that may impact you in 2022.
Emergency Care
Providers are prohibitedfrom balance billing patients for out-of-network emergency services. In somesituations, this may include the following types of services: stabilization andpost-stabilization; patient transfer; ancillary services; and out-patient observationor inpatient or out-patient stays relating to the emergency services.
Informed Consent
The new federal rules allowthat a non-contracted provider may balance bill after the patient isstabilized, if: the patient can travel using non-medical transportation ornon-emergency medical transportation; the provider gave notice that theadditional items/services are non-contracted including the cost; and they’vereceived acknowledgement of the notice from the patient, who’s been determinedcapable of consent.
This provision will notapply in WA for fully insured health plans and those self-funded plans thatopted into the state balance billing protections. This is because the federallaw doesn’t pre-empt state balance billing laws except where the federal protectionsare broader or more favorable to consumers.
Ancillary Services
For ancillary services abalance bill is never allowed (emergency or non-emergency) under the NoSurprises Act. However, there is an exception for certain non-ancillaryservices at an in-network facility where the provider informs the patient inadvance that they are non-contracted and gives them an estimate of the charges.
Air Ambulance
The No Surprises Act coversair ambulance services and prohibits air ambulance providers from balancebilling if they are non-contracted. The law also requires health plans to covernon-contracted air ambulance services for any services that would be covered ifthe air ambulance provider was in-network, and to apply in-network cost-sharingin the same way as other emergency services. Air ambulance providers are alsoincluded in the independent dispute resolution (IDR) process, if needed.
Learn More
Additional provisionsrelated to balance billing have been delayed by the government but should becoming later in 2022. We’ll be communicating more about the No Surprises Act infuture issues of Provider News. Here are some resources are available:
- Federal No Surprises Act Explained
- Understanding Provider Directory Requirements forthe No Surprises Act
- Understanding The No Surprises Act DisputeResolution Process