The federal No Surprises Act became effective Jan. 1, 2022. It established a federal law prohibiting balance billing for out-of-network, self-pay, and uninsured patients from certain surprise medical bills. The law also created patient price transparency rules by requiring certain physicians to provide their patients with good faith estimates.
Texas law and federal legislation both have systems to address payment disputes between physicians and health plans using independent dispute resolution (IDR). But they also have some key differences.
Check out these TMA materials on the independent dispute resolution process, physician charges, and health plan contracting and networks.
Educational Letters to Federal Certified Independent Dispute Resolution (IDR) Entities
Resources Concerning the No Surprises Act
The Real Truth About Surprise Bills
Physician Charges Do Have Meaning
Required Notices: No Surprises Act Notices with Certain Posting Requirements
SB 1264 and Out-of-Network Claims: Texas Arbitration Process
How to Appeal Being Dropped From a Network
Physician Prices, Fee Schedules, and Managed Care Contract Offer and Acceptance
Much of the federal government’s solution to resolve certain out-of-network billing disputes took effect at the start of 2022. To help physician practices understand and navigate the new law, the American Medical Association has created two No Surprises Act toolkits. TMA also offers an updated list of resources on the new law.
Read about Preparing for Implementation of the No Surprises Act.
Read about Disputing Out-of-Network Payments Using the No Surprises Act Independent Dispute Resolution Process.
View the AMA webinar, Out-of-Network Payment Process Under the No Surprises Act, that was held on Thursday, Apr. 21. Access a recording of the webinar and the presenters' slides.
TMA and American Medical Association leaders are urging physicians to get educated now about the new federal law on surprise medical billing. Many related practice changes were the subject of an AMA educational webinar held Jan. 20, which will also be available as a recording.
On Friday, April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) opened the federal Independent Dispute Resolution (IDR) portal process for the No Surprises Act (NSA). It is intended to resolve payment disputes for certain out-of-network charges.
The Texas Medical Association has updated its white paper on Texas’ law for settling out-of-network billing disputes involving state-regulated health plans.
Marking a fourth victory for the Texas Medical Association in as many lawsuits, a court struck down a large portion of the regulations setting forth a methodology insurers use to calculate the qualifying payment amount, or QPA, used in surprise-billing disputes – part of a series of federal rules TMA has long argued skew the arbitration process in insurers’ favor.
Statement by Rick W. Snyder II, MD, Texas Medical Association (TMA) president, in response to the ruling by the U.S. District Court for the Eastern District of Texas on TMA's fourth No Surprises Act lawsuit. TMA challenged a 600% hike in administrative fees and batching rules used in arbitration cases governed by the federal law.
Within days of TMA's Feb. 23 court victory over federal regulators, the U.S. Department of Health and Human Services says it’s taking steps to comply with the court’s decision on rules for the No Surprises Act. However, the case may not be over yet.
When the Texas Medical Association scored a win over federal regulators in a Feb. 23 U.S. district court decision, it wasn’t just a victory for physicians. It was a victory for patients, too. The court sided with TMA in its attempt to stop a piece of rulemaking tied to the federal No Surprises Act.
TMA has sued federal authorities over rulemaking for the federal surprise billing law, saying it failed to follow clear direction from Congress about how to implement the dispute resolution process meant to determine fair payments for out-of-network care.
Pressure is mounting on federal authorities with multiple legal actions, including TMA's, aiming to stop what physicians and hospitals say is an unfair arbitration process outlined in rules implementing the No Surprises Act, legislation passed in 2020 to address surprise medical bills.
TMA has created a draft TDI complaint letter you can customize for your patients. We have it available in both English and Spanish. Complaints about a health plan’s network may include problems locating a specialist who is accepting new patients, finding a doctor within reasonable driving distance from the patient’s home, or inaccurate information in the health plan’s provider directory.
Read Surprise Billing Articles
Some surprises are fun; surprise bills aren't.
TMA has developed a one-page patient handout describing the most common reasons for "surprise" medical bills. There's also a longer document for those who want more details.
No Surprises Act Consumer Webpage (CMS)
Got questions about Surprise Bills? Call the Knowledge Center.
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