Fierce Healthcare September 3, 2021
The No Surprises Act (NSA) was signed into law on December 27, 2020, and provides consumers federal protections against surprise medical bills, prohibits balance-billing for certain out-of-network (OON) care, and drastically changes billing and reimbursement processes.
On July 1, 2021, federal agencies published the first set of regulations to implement the law.
The law imposes a hefty list of new requirements on payers and providers and impacts payers in two significant areas — transparency provisions and OON claims processing and payment, which is the focus of this article.
Out-of-network reimbursement and settlement rules for payers
Starting January 1, 2022, providers are prohibited from balance-billing members for items and services received in three situations: OON emergency, OON nonemergency at in-network facilities...
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