Month: February 2022

The No Surprises Act (NSA) provides consumer protections against unexpectedly high medical bills. When it comes to compliance, the rules differ depending on the situation. For part two, we’re breaking down how to comply with the rules for uninsured or self-pay individuals.

A facility or provider can initiate the federal independent dispute resolution (IDR) process, or depending upon their state, a CMS-approved, state-run dispute resolution process if it thinks the amount remitted by an out-of-network payor is insufficient.

Under the No Surprises Act (NSA), a non-participating or OON provider is prohibited from balance billing patients for scheduled non-emergent services at a participating or in-network (INN) facility unless they properly provide the patient with the standard notice and consent (N&C) developed by the U.S. Department of Health and Human Services (HHS). The patient must sign it to agree to be balance billed.

The No Surprises Act (NSA) requires providers and facilities to communicate consumer protections against balance billing.

There are no easy answers or a “one-size-fits-all” solution to compliance with the No Surprises Act (NSA). Deciphering the law and its requirements is one half of compliance. The other half is doing the hard work of figuring out where the NSA’s various provisions intersect with your facility’s operations and how you’ll create policies and procedures to implement the new requirements. The mechanics of implementation will vary among facilities and healthcare systems.