Detailed Summary of Part 2 of Regulations Banning Surprise Medical Billing

Regulatory Advisory
October 18, 2021

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At A Glance

The departments of Health and Human Services (HHS), Labor, and Treasury, along with the Office of Personnel Management, Sept. 30 released “Part 2” of regulations implementing the No Surprises Act. The interim final rule addresses several provisions in the law, including the independent dispute resolution (IDR) process providers and plans may use to adjudicate outstanding reimbursement disputes, the good faith cost estimates providers must share with uninsured or self-pay patients for scheduled services, a process to resolve disputes between uninsured/self-pay patients and providers, and an external review process as part of the oversight of health plan/issuer compliance. The agencies also established a website (or “Federal IDR Portal”) where interested parties can apply to serve as an IDR entity and where providers and plans may initiate the IDR process.

While many of the policies in the interim final regulations are applicable Jan. 1, 2022, others are effective immediately upon publication in the Federal Register on Oct. 7, 2021. Specifically, the provisions related to the IDR process are now in effect and the departments have begun accepting applications from organizations interested in serving as certified IDR entities through the portal as of Sept. 30, 2021. Stakeholders have until Dec. 6, 2021, at 5 p.m. ET to submit comments. However, the departments do not need to publish an additional final rule prior to these regulations going into effect. View the entire Regulatory Advisory below.

Key Takeaways

The interim final regulations:

  • Establish the federal independent dispute resolution process that providers, facilities, plans, and issuers may use to resolve ongoing reimbursement disputes for out-of-network claims subject to the No Surprises Act. 
  • Require providers to generate and share with uninsured and self-pay patients good faith estimates for all scheduled services, including in instances where the patient may be shopping and not at the point of scheduling.
  • Establish a process for uninsured and self-pay patients to dispute provider charges for care that are at least $400 more than the good faith estimate for those same services.
  • Modify existing external review requirements as part of health plan/issuer oversight to incorporate provisions related to the No Surprises Act.

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