Federal Surprise Billing Rule May Bring Changes for Your Out-of-Network Patients

July 30, 2021

These federal rules do not apply to Medicare and Medicaid, which already have rules related to surprise billing

On July 1, 2021, the Biden Administration released the first of several federal rules that will implement provisions of the No Surprises Act. This law was enacted in late 2020 to protect patients from “surprise billing” for services received from physicians or other healthcare professionals who are not part of their insurance plan network. 

Surprise bills frequently happen when patients choose care at an in-network facility, but end up unknowingly receiving some services from nonparticipating health professionals. Overall, the law prevents health insurers and healthcare professionals from charging patients more for these unexpected out-of-network services, and sets parameters for how reimbursements for the out-of-network services will be determined. 

This first interim proposed rule offers additional guidance on the types of services that will be subject to the law, as well as specific requirements to ensure patients are held harmless from surprise bills. Note that subsequent rules are expected to be issued later this year, which will include guidance on the process for determining final payment amounts to healthcare professionals and facilities.