Surprise Billing Regulations: Out-of-Network Providers at In-Network Facilities | K&L Gates LLP
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Surprise Billing Regulations for Out of Network Providers at In Network Facilities
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On 1 July 2021, the United Stated Office of Personnel Management, and the Departments of the Treasury, Labor, and Health and Human Services (collectively, the Departments) issued an Interim Final Rule
1 (the IFR) implementing the No Surprises Act,
2 enacted to ban surprise medical bills effective 1 January 2022. For out-of-network providers, the IFR bars health care providers who are not contracted to health plans from billing patients more than would be paid for in-network services in emergencies and in other specified nonemergency situations. Intended to provide patients protection against unanticipated medical expenses, the IFR will remove the predominant methodology used by health plans to pay out-of-network providers under the Affordable Care Act (ACA).