Last Thursday, the Biden administration unveiled the Interim Final Rule, indicating how the No Surprises Act will be implemented. While comments are being solicited until September 1, HHS chose to skip a Proposed Rule and go straight to an Interim Final Rule, most provisions of which will be effective January 1, 2022. 

Congress approved the No Surprises Act last December in order to eliminate so-called “surprise billing.” The Rule requires billing in emergency situations to match in-network rates with no requirement for prior authorization. The rule also prohibits out-of-network charges for ancillary services, such as radiology, anesthesia, and other providers, at an in-network facility. 

Restrictions on out-of-network charges also apply to non-emergency situations, such as childbirth. How these provisions will apply to specialists is of particular interest and concern, and may lead to tension between providers and patients, according to Axios.  In most, if not all, cases, providers will be required to post notices related to possible out-of-network billing.

Not addressed in the rule was an arbitration process, required by legislation, for cases where in-network rates are not established. Ground ambulance billing is also not addressed because it was excluded from last year’s legislation. 

To learn more, please find additional coverage on the Interim Final Rule:

Radiology Business: Surprise Medical Billing Ban One Step Closer as Biden Administration Unveils Final Rule

Modern Healthcare: CMS Bans Surprise Billing

Fierce Healthcare: Biden Admin Releases First Rule Banning Surprise Medical Bills