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
Enhancing School Security: Practical Strategies for Safer Campuses
Enhancing school security is one of the most pressing responsibilities for education leaders today. As school campuses evolve, so too must the systems that protect them. For administrators, safety professionals, and district decision-makers, creating a secure learning environment means taking a proactive, layered approach that includes physical security, training, technology, and community involvement.
5 Common Cybersecurity Mistakes and How to Avoid Them
All organizations, regardless of their size or industry, are at risk of being targeted by cybercriminals. These malicious actors can conduct cyberattacks, leading to significant financial, operational and reputational damage that can be difficult or impossible to recover from. Fortunately, solid cyber hygiene practices can reduce the likelihood of data breaches and other cyber incidents from occurring, and many of these practices are relatively low-cost and easy to implement.
Insurance Coverage Basics For Boatowners
A small boat, such as a canoe or other un-motorized boat, is typically covered under the personal property portion of your homeowners insurance policy. If you own a larger, faster boat, you'll need a separate boatowners insurance policy. A typical boatowners insurance policy is designed to protect your boat, motor, equipment, and passengers. It affords similar coverages to those you typically have for your car including: