Why hospitals are worried about the No Surprises Act

Katie Adams

Hospitals are concerned that the No Surprises Act won't address the main problems driving high surprise medical bills and that its implementation date is coming too soon for them to adequately prepare, Bloomberg Law reported Sept. 23.

The No Surprises Act, a measure to end surprise medical bills for emergency and scheduled care, was passed in December when then-President Donald Trump signed into law a $1.4 trillion year-end spending bill. 

CMS unveiled an interim final rule addressing several provisions in the No Surprises Act in July. Most provisions outlined in the proposed rule will not take effect until Jan. 1, 2022. 

Hospitals argue the rule won't do enough to address the inadequacy of healthcare provider networks, which are critical to avoiding surprise billing in the first place.

Disruption could occur among healthcare provider networks "if plans and issuers are able to pay less for services under the provisions of the No Surprises Act than by contracting at commercially reasonable rates with providers and facilities," the American Hospital Association said in a letter to HHS, the Internal Revenue Service and the Office of Personnel Management.

The AHA also said the rule doesn't address every instance of out-of-network care, nor cases in which plans or issuers label a provider as in-network but then fail to cover medically necessary services that provider delivered. 

Hospitals also are worried about meeting the rule's requirements by 2022, saying they don't have enough time to prepare their billing departments or deploy patient communications about the law.