The No Surprises Act (NSA) is a federal law effective January 1, 2022, designed to protect patients from unexpected medical bills by limiting their out-of-pocket costs for certain out-of-network services to no more than in-network amounts. The NSA applies to emergency services, non-emergency services provided by out-of-network providers at in-network facilities, and air ambulance services. It imposes requirements on healthcare facilities, providers, and insurers, including:

Restricting surprise billing for emergency and certain non-emergency care.

Establishing an independent dispute resolution (IDR) process for payment disputes between providers and insurers.

Requiring good-faith estimates for uninsured or self-paying individuals.

Providing a patient-provider dispute resolution process and appeals for certain health plan decisions.

The NSA’s implementation has been shaped by ongoing litigation, particularly in states with their own specified laws, leading to operational challenges and confusion. The law also outlines strict timelines for payment, negotiation, and dispute resolution, with enforcement primarily handled by federal agencies. Despite these protections, there is no private right of action to enforce IDR determinations in court, and enforcement remains the responsibility of federal agencies. Since inception, the NSA has resulted in significant costs, a high volume of disputes, and evolving regulatory guidance.

This program is approved for CLE in CA, IL, NJ, NY, PA and TX.

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