Industry News

On December 10, 2021, the Kaiser Family Foundation (KFF) released its issue brief, No Surprises Act Implementation: What to Expect in 2022. The No Surprises Act (NSA) establishes new federal protections against surprise medical bills that take effect in 2022. Surprise medical bills occur when insured consumers unintentionally receive care from out-of-network hospitals, doctors, or other providers.

The No Surprises Act prohibits providers from billing patients more than the applicable in-network cost sharing amount. Beginning in 2022, providers will need to determine the patient’s insurance status before submitting the surprise out-of-network bill directly to the health plan. However, patients can give written consent to waive their rights under the No Surprise Act and may be billed more by out-of-network providers.

The brief outlines what to expect in 2022 and summarizes key provisions that will be implemented. It also describes the procedures for payment amounts for surprise bills including the use of an independent dispute resolution (IDR) system. In addition to compliance, monitoring the impact of the NSA may be accomplished in various ways including: 1) data reporting by IDR entities will provide some information; 2) annual health plan audits conducted by federal agencies to provide information about prices charged and paid for surprise bills; and 3) state systems may provide important data on how the law is working. Overall, oversight and enforcement may rely on various complaints. 

The issue brief is available here.