On Aug. 19, 2022, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) jointly released a final rule implementing the ban on surprise medical billing under the No Surprises Act (NSA), which was enacted as part of the Consolidated Appropriations Act, 2021 (CAA).
This rule finalizes two interim final rules released in July 2021 and September 2021, with certain changes related to the independent dispute resolution (IDR) process that has been the subject of ongoing litigation.
The Departments also released FAQs on NSA implementation in conjunction with the final rule that provide more detail on the surprise medical billing ban.
Surprise Medical Bills
Surprise medical bills occur when patients unexpectedly receive care from out-of-network providers (for example, treatment at an in-network hospital involving an out-of-network doctor). Patients often cannot determine the network status of providers during treatment to avoid additional charges and, in many cases, are not involved in the choice of provider at all.
Overview of the Final Rules
The final rule is generally intended to make certain medical claims payment processes more transparent and clarify the process for providers and health insurers to resolve their disputes. It:
- Implements certain disclosure requirements related to information that group health plans and health insurance issuers offering group or individual health coverage must share about the qualifying payment amount (QPA) (generally, the health plan's median contract rate for the item or service in the geographic area);
- Finalizes certain changes related to the federal IDR process in light of ongoing litigation; and
- Requires plans and issuers to disclose additional information in situations where they change a provider's billing code to one of lesser value (lowering the payment to the provider).
For more information on employee benefits, contact INSURICA today.
This is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice. © 2022 Zywave, Inc. All rights reserved.
About the Author
Share This Story
Related Blogs
Making an Acquisition? Why the EMOD Shouldn’t Be Overlooked
When acquiring another company, there’s no shortage of factors to consider. From valuing physical assets to estimating potential synergies, the due diligence process can be complex. However, one critical element often overlooked is the EMOD.
2026 Employer Mandate Update
In July 2025, the IRS released new guidance increasing both the affordability percentage and penalty amounts under the Affordable Care Act’s employer mandate for the 2026 plan year. These changes will affect how Applicable Large Employers (ALEs) determine affordability and assess compliance risk moving into the next benefits cycle.
Facility Rental: Best Practices for Non-School Use
As community hubs, school districts often open their doors to outside organizations for events, activities, and gatherings. This facility rental for non-school use can benefit the community, but it also comes with potential risks. School administrators must take proactive steps to protect district property, reduce liability exposure, and ensure compliance with state laws.