No Surprises Act: What Providers Need to Know

healthcare providers

Part 3 of our No Surprises Act blog series

The No Surprises Act requires healthcare providers to be clear and transparent about their billing practices and what patients should expect to pay for medical treatment.

The new law protects patients from balanced billing and other medical bills not expected at the time of treatment. Impacted facilities and individual providers should already have measures in place to be compliant—we’ll go over the basics here.

Medical Provider Compliance

Healthcare facilities, providers, and health insurance companies must provide an easy and accessible explanation of the No Surprises Act, the federal/state requirements and prohibitions related to balance billing, good faith estimates for the uninsured or self-pay patients, and agency contact information for filing complaints.

This information should appear on the homepage of websites and be visible in physical locations.

The law applies to:

  • Health Care Facilities
  • Emergency Health Care Facilities, such as:
    • hospital emergency departments
    • independent, freestanding emergency departments
  • Providers, such as:
    • Physician Assistants
    • Nurse Practitioners
    • Anesthesiologist assistants
    • Certified registered nurse anesthetists
    • Physical and occupational therapists
    • Laboratory service providers
    • Psychologists
    • Air Ambulance Providers

Tools and resources

As surprise medical bills can be overwhelming for patients, the No Surprises Act requirements can be overwhelming for healthcare providers. The American Medical Association has an online toolkit for providers looking for guidance on operational challenges they need to address.

The toolkit explains rules for emergency care and patients who cannot or do not consent to out-of-network post-stabilization care. It also answers questions about good faith estimates and how quickly they must be provided for self-pay and uninsured patients.

In addition, requirements ensuring patients receive notice and consent to care provided by out-of-network clinicians at in-network facilities are discussed in the toolkit. The Department of Health and Human Services also offers a model notice providers can use to provide patients with disclosures regarding their protections regarding the No Surprises Act.