New Surprise Billing Regulation Could Favor Providers

In the latest round of rulemaking on the No Surprises Act (NSA), the 2020 law that bans most balance medical billing, providers won concessions from the Biden administration regarding the calculus arbitrators must use to decide billing disputes. One expert tells AIS Health, a division of MMIT, that the new regulation, which takes recent pro-provider court decisions into account, is likely to reduce the amount of cost savings the NSA generates for payers.

The NSA bans the practice of balance, or “surprise” billing. Surprise bills typically involved pricey emergency care, and frequently saddled patients with crippling amounts of medical debt — often tens of thousands of dollars. Patients were charged the cost of care delivered by providers outside their insurance network when the plan and provider couldn’t agree on a fair price for treatment. The law compels health plans and providers to attempt to work out the balance billing disputes between themselves.

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• Health Plan Weekly