Introduction

Special Audio Conference —
New Surprise Billing Rules – What they Say and What You Need to Do About Them

On July 1, 2021, HHS and several other federal agencies issued an interim final rule called “Requirements Related to Surprise Billing; Part I” aimed at what it claims are excessive out-of-pocket costs to consumers from so-called “surprise billing” and balance billing by providers. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network for both emergency and non-emergency care. The rule was issued pursuant to the “No Surprises Act” which was part of the Consolidated Appropriations Act 2021. The regulations will take effect for health care providers and facilities on January 1, 2022.

On the surface, the rule is pretty straightforward. Among other provisions, the rule will prohibit:

• surprise billing for emergency services;
• high out-of-network cost-sharing for emergency and non-emergency services;
• out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility; and
• other out-of-network charges without advance notice.

However, as with almost any regulation, the devil is in the details. A number of key questions still need to be answered. And the rule will surely have a lot of unintended consequences for hospitals and doctors for years to come.

We are offering this special audio conference, available now for purchase. Attorneys Dan Mulholland, Henry Casale, and Mary Paterni will explain the rule, and explore some of the things that you will need to consider between now and January 1, such as:

• Does the rule make EMTALA applicable to inpatients?
• The effect of the new rule on contracts with hospital-based physician groups such as anesthesiologists, pathologists, radiologists and emergency physicians.
• What you might want to consider in terms of modifying your physician employment and recruitment contracts.
• Whether this rule could extend to any physician on the hospital medical staff – employed or not – and how this might affect your credentialing procedures.
• The extent to which this rule, coupled with the hospital price transparency rules already in effect, will affect negotiations with third-party payors.
• How to draft a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before you can bill at a higher out-of-network rate.

Please join us for this thought-provoking discussion of the first of several new rules that will affect how you do business for years to come.

Please note: This is not a live audio conference. This presentation is recorded and only available for purchase.