Compliance with requirements in the No Surprise Act went into effect on January 1. To help physicians comply with the new requirements, the American Medical Association has developed a No Surprises Act Tool Kit. The AMA plans to update Tool Kit as guidance changes.
Provider and facility disclosure requirements
Each provider, hospital and ASC, is required to make publicly available, including on its website and to each patient who is enrolled in commercial health coverage, a disclosure regarding the patient protections against balance billing. The U.S. Department of Health and Human Services (HHS) has created a model notice that providers and facilities should use. The notice must be provided individually to commercially insured patients, including those in the Federal Employees Health Benefits Program (FEHBP), no later than the time a bill is sent to the patient or a claim for payment is submitted to a health plan. Model notice and instructions are available here.
Providers only need to provide notice if they provide care in a hospital or an ASC, or in connection with a visit to a hospital or an ASC. Providers do not need to post the notice at their location or furnish it to patients if the hospital or ASC does so. Providers should enter written agreements for the facilities to provide these notices.
Providers still need to post the notice on their website if they have one.
Additional resources on Surprise Billing can be found on the Centers for Medicare and Medicaid Services’ website.