AMA Toolkit Dissects Federal Surprise Billing Law
By Joey Berlin

Much of the federal government’s solution to resolve certain out-of-network billing disputes without balance billing or otherwise involving patients – known as the No Surprises Act – took effect at the start of 2022.

Among other pieces physicians must familiarize themselves with, the new federal law features an independent dispute resolution (IDR) process that was intended to let physicians and insurers both make their case for fair payment. Naturally, plenty of minutiae and arcana exists within the law, and a portion of the rules for the IDR process is under a legal challenge from the Texas Medical Association and others in organized medicine.

To help physician practices understand and navigate the new law, the American Medical Association has created a toolkit, Preparing for Implementation of the No Surprises Act. The 20-page toolkit includes information on:

  • Operational challenges physicians “will need to address immediately” to be compliant with the law’s new requirements, such as when uninsured and self-pay patients must receive a good-faith estimate of charges before they receive services;
  • What services and care fall under the rules of the No Surprises Act;
  • Timetables and requirements for the IDR process; and
  • When and how facilities and physician practices can obtain a patient’s consent to balance bill for out-of-network care at an in-network facility.

AMA says it will update the toolkit “as additional guidance is available” and will develop new resources on parts of the law not already included in the toolkit.

For additional information on the No Surprises Act, you can check out TMA’s list of resources on the law, which has both similarities and differences to Texas’ IDR law governing state-regulated health plans.

Meanwhile, TMA and others are still pushing to ensure the implementation of the law is fair for physicians seeking to get paid. In late October 2021, TMA filed suit to challenge what physicians and hospitals say is an unfair piece of the IDR process outlined in federal rules. Check future editions of Texas Medicine Today for updates on that lawsuit.

Last Updated On

April 05, 2022

Originally Published On

January 06, 2022