No Surprises Act – Federal Law on Balance Billing


October 12, 2021

Nashville, TN – Congress passed the No Surprises Act (NSA) in December 2020 as part of the Consolidated Appropriations Act (page 1577). It is effective on Jan. 1, 2022 and will apply to all insurance plans (including ERISA plans) except for Medicare, Medicaid, and TRICARE. These three plans already prohibit balance billing of patients by a healthcare provider.

Rules to provide detail on the implementation of the NSA were published in the Federal Register on July 13, 2021. These rules have been codified in the Code of Federal Regulations at 45 C.F.R. § 149.10 to § 149.450.

The NSA prohibits balance billing for the following:

Emergency Services at an Out-Of-Network Facility; 

Non-Emergency Services from a Non-Participating Provider at a Participating Facility; and

Air Ambulance Services.

TMA is planning a series of articles to discuss these rules and the impact on physician practices. These articles will cover topics such as services at out-of-network facilities and in-network facilities by out-of-network providers, required patient notices and consents, out-of-network rate paid by insurance plan, independent dispute resolution, and the good faith estimate. If you have any questions, contact legal@tnmed.org or 615-460-1645.