QUESTION:
I noticed that part two of the surprise billing rules were published.  Do these new rules require any action prior to their January 1, 2022 effective date?

ANSWER:
The surprise billing saga continues! Are you ready for January 1?

By way of background, on July 13, 2021, the Departments of Health and Human Services, Labor, and Treasury published an interim final rule implementing certain provisions of the No Surprises Act, which was enacted as part of the Consolidated Provisions Act of 2021.  Effective January 1, 2022, the interim final rule affords patients protection against balance billing and cost sharing for certain out-of-network services, prohibits out-of-network providers and health care facilities from balance billing patients under specific circumstances absent notice and consent, and requires providers to disclose federal and state patient protections against balance billing.  You can tune in to our audio conference or read about it here to learn more about what part one of the Surprise Billing rules require of you.

On September 30, 2021, the Departments issued a second interim rule with additional provisions aimed at protecting consumers from surprise medical bills under the No Surprises Act.  Among other things, this rule removes the consumer from payment disputes by requiring providers and health plans to follow outlined payment dispute processes to resolve any remaining costs for out‑of-network services not billed to the patient.

In addition, beginning January 1, 2022, providers will be required to provide uninsured and self‑pay consumers “good faith” estimates of expected charges for items or services within one business day after scheduling or within three business days after the consumer requests the estimate.  A “good faith” estimate should include an itemized list of and expected charges for the scheduled item or service and any other related item or service likely to be provided.

In anticipation of these rules taking effect, you should begin to review the dispute resolution language in your payor contracts, if such language exists, to ensure that it is aligned with the processes outlined in the second interim rule.  You should also begin drafting a good faith estimate form or adopt CMS’ template, which can be found here.

Tune in to our next surprise billing audio conference on January 4, 2022 for more information on the implementation of the Surprise Billing rules.