Surprise Billing and How It Affects Doctors
As a doctor in the health care field, have you heard about surprise billing? If so, does your practice know about the No Surprises Act that went into effect on January 1, 2022? If not, it should.
When a patient receives a service from a health care provider that was not in the patient’s insurance network, the patient will very likely receive a bill for that out-of-network provider’s services. This type of situation could lead to confusion and anger for the patient when they receive one bill for for charges not covered by their in-network doctors as well as another bill (or bills) from the out-of-network doctor. For the doctors involved in a particular instance of patient care (or numerous instances in a single, multi-faceted visit), it could lead to angry patients as well as non-payment and unexpected profit loss.
For example, if a patient goes to the emergency room for stomach pain and their care team discovers a heart issue that is treated by a cardiologist who is not in their network list of providers, it won’t be long before this same patient receives a bill for services done during this visit by any in-network provider as well as an additional, unexpected bill for the out-of-network cardiologist for care received during this same ER visit.
Situations like this led to the creation of the No Surprises Act.
The No Surprises Act also bans:
Safeguard Your Practice
The No Surprises Act requires that health care providers and facilities provide consumers with an easy-to-understand notice explaining the way they bill, who to contact if they have concerns that a provider or facility has violated the billing protections, and that patient consent is required to waive billing protections (i.e., they must receive notice of and consent to being balance billed by an out-of-network provider). 
For more information about the No Surprises Act, visit CMS.gov/nosurprises, or call the Help Desk at 1-800-985-3059. TTY users can call 1-800-985-3059.
1 The No Surprises Act Explained | The PHIA Group
2 No Surprises: Understand your rights against surprise medical bills | CMS