On Aug. 19, 2022, the Departments of Health and Human Services, Labor, and Treasury issued final rules pertaining to provisions in the No Surprises Act, titled “Requirements Related to Surprise Billing: Final Rules.”
The rules finalize requirements under the July 2021 interim final rules regarding information about the qualifying payment amount that group health plans and health insurance issuers are required to share.
The rules issued on Aug. 19 also finalize certain requirements under the October 2021 interim final rules regarding information that needs to be considered when certified independent dispute resolution (IDR) entities make a payment determination under the federal IDR process. These modifications were made to comply with judgments rendered by the U.S. District Court for the Eastern District of Texas in February and July 2022 in which the court vacated portions of the October 2021 interim final rules related to payment determinations.
According to an overview on the Centers for Medicare & Medicaid Services website, the rules lay out the IDR process that providers, facilities, and air ambulance providers can follow for certain out-of-network claims when open negotiations do not result in an agreed-upon payment amount. Providers, facilities, and air ambulance providers are “required to meet deadlines, attest to no conflicts of interest, choose a certified IDR entity, submit a payment offer and provide additional information if needed,” such as level of training, experience, and severity of condition.
Additionally, providers, facilities, and air ambulance providers are required to give good-faith estimates of expected charges for scheduled health care services to uninsured, or self-pay, individuals. If billed charges are higher than the good-faith estimates, they may need to participate in a patient-provider payment dispute resolution process.