Lexology January 6, 2021
On December 28, 2020, Congress passed an appropriations act for coronavirus relief that included the No Surprises Act. This Act generally prohibits balance billing and contains other consumer protection and transparency requirements that may fundamentally change health payor and provider operations.
One key aspect of this Act is the new framework for rate disputes between commercial payors and providers. Under the Act, provider rates will be determined by various methods, depending upon whether the provider is in network or out of network, with special terms applicable to emergency services and air ambulance services.
Section 103 of the No Surprises Act establishes the process for non-emergency medical services rendered by out-of-network providers. The Act establishes an Independent Dispute Resolution (IDR) process...
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