CMS just released its new ‘surprise’ billing rule—and hospital groups are furious

CMS on Thursday released an interim final rule establishing a process to settle disputes between out-of-network providers or facilities and health plans over so-called “surprise” medical bills, which occur when an out-of-network provider participates in a patient’s care at an in-network facility.

Radio Advisory: The biggest transparency and surprise billing policies coming your way

Background

The new rule builds upon a prior rule that CMS released in July known as “Requirements Related to Surprise Billing; Part I.” That rule restricted out-of-pocket costs for consumers as a result of surprise and balance billing.

Specifically, the “Part I” rule banned balance billing for emergency services, required that patient cost-sharing for emergency services and some non-emergency...