CMS releases No Surprises Act implementation FAQs

Wednesday, July 6, 2022

CMS recently released FAQs on No Surprises Act implementation topics including balance billing and notice and consent requirements.

The FAQs are grouped into two general topics: applicability and notice and consent.

The applicability section addresses questions about which organization types the various requirements apply to. Generally, the requirements on balance billing apply to providers, emergency facilities, and nonemergency facilities that do not participate in a patient’s group health plan or individual health insurance coverage. However, certain providers practice in settings that don’t trigger the No Surprises Act’s balance billing requirements. The FAQs include a table that summarizes how the act’s balance billing requirements apply to providers and facilities by category of services.

The FAQs also clarify that the act’s balance billing protections do not apply to Medicare, Medicaid, or other beneficiaries of federal programs such as the Indian Health Service or TRICARE. These programs have existing medical bill protections.

The notice and consent section provides additional information on when organizations must provide notice and seek consent to waive the act’s balance billing and cost-sharing protections, the form in which the notice must be given and the consent obtained, and more. Organizations are required to use a standard notice and consent form published by HHS.

Revenue integrity professionals should review the FAQs and ensure they’re distributed to other stakeholders throughout their organization. Education and training materials should be updated. Processes and workflows should be reviewed and, when necessary, updated to bring them in line with CMS’ guidance. Compliance gaps should be resolved and followed up on to make sure the issues do not reoccur.

Editor’s note: Find more NAHRI resources on the No Surprises Act here.