On August 19, the U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury released new regulations implementing provisions of the December 2020 No Surprises Act. “Requirements Related to Surprise Billing: Final Rules” readdresses provisions previously addressed in two Surprise Billing final rules issued in 2021 but later vacated after legal challenges in the United States District Court for the Eastern District of Texas.
The new 146-page rule is mainly limited to revising the payment determination process to be used in settling disputes between payers and providers. Critically, this rule does not change previously finalized regulations regarding Good Faith Estimate (GFE) requirements for healthcare providers. It also does not include any updated guidance regarding GFE requirements for “co-providers”, as CMS has promised it would do before those provisions go into effect on January 1, 2023.
As this latest final rule primarily impacts hospitals and facility-based providers, it is unlikely to impact physician groups, unlike any future regulations or guidance pertaining to GFE requirements.
For more information about this rule, see here, here, and here.
For more information on using NextGen Healthcare solutions to help meet GFE requirements, visit the Success Community.