Understanding the No Surprises Act

Get up to date on the “No Surprises Act”, which went into effect on January 1st, and what this means for your practice.

The “No Surprises Act” requires that patient cost-sharing, such as copayments, co-insurance, or a deductible cannot be higher than if such services were provided by an in-network provider, and any cost-sharing obligation must be based on in-network provider rates. This act prohibits out-of-network charges for items or services provided by an out-of-network provider at an in-network facility, unless providers and facilities provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill the patient more than in-network cost-sharing rates. This Act also addresses providing a Good Faith Estimate through notice and consent to patients considered uninsured or self-pay.