AMA Creates No Surprises Act Toolkit

The American Medical Association (AMA) created a toolkit for physicians on implementation of the No Surprises Act (NSA). Many provisions took effect on January 1, and this document provides guidance on several of those provisions.

The federal No Surprises Act (NSA) prohibits out-of-network health care providers and facilities from balance billing commercially insured patients, in certain circumstances. The NSA and its implementing regulations set a method for determining the patient cost-sharing for these out-of-network situations, and when state law does not establish a provider payment methodology, the NSA establishes an independent dispute resolution (IDR) arbitration system to establish provider payment.

This toolkit addresses three operational challenges that physicians will need to address immediately to be compliant with the new requirements.

• Part I: Non-emergency services at in-network facilities — notice and consent requirements that allow out-of-network physicians to balance bill when seeing patients at in-network facilities, as well as situations in which such patient consent is not or cannot be obtained.

• Part II: Emergency services and post-stabilization care at hospitals or freestanding emergency departments — rules applicable to emergency care, especially circumstances in which out-of-network providers can balance bill for care after an out-of-network emergency.

• Part III: Good faith estimates (GFEs) for self-pay and uninsured patients — obligations to provide a GFE of provider charges for scheduled self-pay and uninsured patients, including dispute resolution for bills substantially in excess of the GFE.

When the AMA updates the toolkit as additional guidance becomes available, and develops new resources on the remaining NSA provisions not included in this document, we at the AMCNO will update our members as we receive the new information.