CMS has so far unveiled part one and part two of the No Surprises Act, a bill that has some hospitals concerned about its rapidly approaching implementation date of Jan. 1, 2022, and that it doesn't do enough to address the reasons behind high surprise medical bills.
HealthAffairs reported that there is at least one more interim final rule expected that will add the independent dispute resolution and the patient dispute resolution process.
Here are 12 things to know about the the act so far:
From prior interim final rule July 2:
1. The act bans surprise billing for emergency services and requires providers to bill on an in-network basis. It also proposes that patient cost-sharing can't be higher than services would be by an in-network physician.
2. The rule bans surprise billing ancillary services, always prohibiting out-of-network charges in in-network facilities.
3. It creates a consent process to allow patients to waive their balance billing protections and agree to out-of-network charges.
4. Providers must publicly inform patients about their surprise-billing protections.
5. CMS defined the qualifying payment amount, which calculates patient cost-sharing, as the issuer's median in-network rate for 2019 trended forward.
6. CMS will establish a process that allows patients to submit complaints about any violations to the balance-billing process.
From proposed rule Sept. 10:
7. HHS proposed requiring health insurers to disclose how brokers and agents are directly and indirectly compensated for helping with individual health insurance and short-term insurance enrollment.
8. Issuers would be required to report to HHS their total compensation paid by the issuer to individual agents and brokers for the previous year.
9. The proposed rules have a process for CMS to follow to determine if states are enforcing surprise billing protections. If they fail to enforce protections, CMS could impose civil monetary penalties of $10,000 per violation.
10. HHS proposed that air ambulance providers submit data for each air ambulance claim and transport for the two years covered by the reporting requirements in the act. This will help develop a public report on air ambulance systems.
Why are hospitals worried?
11. The No Surprises Act has some hospitals worried that they don't have enough time to prepare their billing departments by 2022.
12. They're also worried that the act doesn't fully address the inadequacy of healthcare networks, which is a major driver behind surprise medical bills.