No Surprises Act FAQ Tackles Surprise Billing Provisions

The recently published FAQ addresses questions related to the implementation of the No Surprises Act.

The Departments of Health and Human Services, Labor, and Treasury recently released a series of frequently asked questions (FAQ) related to the No Surprises Act.

The FAQs cover common questions including balance billing prohibitions, the application to plans without a network or with a closed network, and emergency services provided in a behavioral health crisis facility.

For example, one question asks if the surprise billing provisions of the No Surprises Act apply in the case of a group health plan or group or individual health insurance coverage that generally does not provide out-of-network coverage.

In this instance, the answer is yes. According to the FAQ, the No Surprises Act’s protections regarding emergency services, non-emergency services furnished by a nonparticipating provider with respect to a visit to a participating facility, and air ambulance services apply if those services are otherwise covered under the plan or coverage, even if the plan or coverage otherwise does not provide coverage for out-of-network items or services.

This FAQ comes on the heels of a new final rule and additional guidance to further implement the independent dispute resolution process and require payers to provide additional information to providers about the qualifying payment amount.