Requirements Related to Surprise Billing: Policy Update

The US Departments of Health and Human Services, Treasury and Labor, and the Office of Personnel Management issued an Interim Final Rule with comment implementing portions of the No Surprises Act, legislation enacted in December 2020 that bars surprise billing beginning January 1, 2022. Under the law, payers and providers (including hospitals, facilities, individual practitioners and air ambulance providers) are prohibited from billing patients more than in-network cost-sharing amounts in emergency and non-emergency circumstances. This IFR establishes regulations defining the payment methodology. The regulation proposes the methodology payers must use to determine cost sharing; the information payers must share with out-of-network providers; the process for submitting and receiving consumer complaints; and the format and details of the notice and consent requirements.

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Eric ZimmermanEric Zimmerman
Eric Zimmerman is a recognized Medicare law and policy authority and registered lobbyist who represents clients before Congress and administrative agencies, and helps clients navigate federal legislative and regulatory processes related to Medicare coverage, coding, reimbursement and compliance. Eric is partner-in-charge of the Firm's Washington, DC Health Industry Advisory Practice Group. He also serves as a principal of McDermott+Consulting LLC. Read Eric Zimmerman's full bio.


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Judith WethallJudith Wethall
Judith Wethall focuses her practice on employee benefits, specifically health and welfare programs. She counsels employers, plan administrators, insurers and consultants on a wide range of ERISA compliance issues. Judith's clients include sole proprietors to Fortune 100 companies and cover a variety of industries including health care, technology, manufacturing, insurance and financial. Read Judith Wethall's full bio.

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