No Surprises Act Goes Into Effect, Subjecting Providers to Possible Billing Dispute Resolutions

The No Surprises Act went into effect on January 1, 2022, to provide a mechanism to resolve payment disputes over out-of-network billing. A lawsuit filed on December 8, 2021, by a coalition of stakeholders representing hospitals, health systems, and physicians sued the federal government today over the misguided implementation of the federal surprise billing law.

Under the current interpretation, federal regulators have directed arbiters under independent dispute resolution to presume that the median in-network rate is the appropriate out-of-network rate. Arbiters are also advised to limit when and how other factors come into play and to limit the use of other dispute resolution mechanisms.

A guide for physicians has been developed and is available for free by clicking the following link.