Surprise Billing: An Overview of the Federal No Surprises Act

An ISMIE report on reducing patient safety risks and exposures.

Surprise Billing OverviewOur risk management program combines online education with personalized, on-site risk assessments to help policyholders improve patient safety, reduce risk exposure and advance their quality of care.

In December 2020, Congress passed the No Surprises Act (NSA), which was part of the Consolidated Appropriations Act of 2021. The provisions in the NSA were intended to protect patients from unexpected medical bills incurred as a result of potentially confusing in-network/out-of-network relationships between physicians, healthcare facilities, and insurance plans. Specifically, the NSA was enacted to prevent patients from receiving “surprise bills” for services received from physicians or other healthcare professionals who are not part of the patient’s insurance plan provider network. Many of the provisions of the NSA became effective Jan. 1, 2022.

The NSA is a federal law, and protects most patients with private health insurance. It applies to patients who are insured through employer-sponsored group health plans (those generally regulated by ERISA are exempt from state-level insurance regulations) and individual plans purchased through the health insurance exchanges or on the individual market. The Act does not apply to Medicare and Medicaid, which already have protections against surprise billing.

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