Compliance Briefing — January 1, 2022
The No Surprises Act now shields U.S. patients from out-of-network balance billing, requiring accurate disclosures, good-faith cost estimates, and structured dispute resolution between providers and payers.
Executive briefing: The No Surprises Act provisions of the Consolidated Appropriations Act, 2021 took effect on 1 January 2022. Group health plans, insurers, hospitals, and clinicians must remove surprise billing for emergency services, post-stabilisation care, and certain ancillary services while following new notice, consent, and payment dispute rules.
Key compliance checkpoints
- Balance billing prohibitions. Ensure patients are only billed in-network cost sharing for covered emergency and air ambulance services.
- Good-faith estimates. Provide uninsured or self-pay patients with written good-faith estimates prior to scheduled services and coordinate provider-directory accuracy.
- Independent dispute resolution (IDR). Establish workflows for initiating the federal IDR process within the 30-business-day negotiation window.
Operational priorities
- Contract updates. Align payer-provider agreements with NSA requirements for payment timelines, data sharing, and patient notices.
- Claims systems. Configure adjudication rules to apply qualifying payment amounts, track cost-sharing, and flag services subject to NSA protections.
- Provider education. Train registration, billing, and clinical staff on notice-and-consent rules and documentation retention.
Enablement moves
- Centralise NSA compliance oversight with dashboards tracking IDR outcomes, patient complaints, and corrective actions.
- Integrate NSA requirements into revenue cycle audits and patient access scripts to reduce compliance drift.
- Coordinate with state regulators to reconcile overlapping state surprise-billing laws and determine primary jurisdiction.
Sources
- 86 FR 36872 — Requirements Related to Surprise Billing
- CMS No Surprises Act consumer protections overview
Zeph Tech helps payers and providers embed NSA controls across contracting, revenue cycle, and patient communications while monitoring IDR performance.