How does the No Surprises Act impact providers?
Asked by: Carolina Welch | Last update: September 5, 2025Score: 4.2/5 (50 votes)
Does the No Surprises Act apply to physician offices?
No. The No Surprises Act currently does not apply if you receive your services in a physician's office/clinic.
What is the No Surprise Act for convening providers?
The convening provider is the physician or provider who receives the initial request for a GFE from an uninsured or self-pay patient and who is responsible for scheduling the primary service. The obligation to provide a GFE for a scheduled service is not dependent on the patient requesting the GFE.
How might unexpected billing disputes impact a provider's relationship with patients and overall revenue management?
Loss of Reputation and Patient Trust
Patients may seek care elsewhere, resulting in a decline in patient volume and revenue. Inaccurate coding and billing can lead to reputational damage for healthcare providers, affecting patient trust, referrals, and overall revenue.
What is NSA in healthcare?
The No Surprises Act (NSA) establishes new federal protections against surprise medical bills that take effect in 2022. Surprise medical bills arise when insured patients inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose.
No Surprises Act Explained
How does the No Surprise Act affect providers?
If a provider or facility is not satisfied with the initial payment from a health plan for out-of-network services covered by the Act, the provider or facility may attempt to negotiate a satisfactory payment with the plan.
Why is the NSA so important?
What does the NSA do? The National Security Agency leads the U.S. government in cryptology that encompasses both signals intelligence (SIGINT) insights, cybersecurity products and services and enables computer network operations to gain a decisive advantage for the nation and our allies.
What are the cons of the No Surprise Act?
The drawbacks may include: Negotiated rates where fees may be less than what might otherwise be charged. Increased scrutiny for credentialing and practice. Added administrative complexity.
What are the benefits of the No Surprise Act?
The No Surprises Act covers most emergency services, non-emergency services from out-of-network providers at certain in-network healthcare facilities, and services from out-of-network air ambulance service providers. It does not cover every unexpected or high medical bill.
How does billing impact the healthcare organization?
Efficient coding and billing practices contribute to a smoother revenue cycle, ensuring that healthcare providers are compensated for their services. Moreover, accurate coding reduces the risk of audits and penalties from insurers, ensuring compliance with healthcare regulations.
What is the primary purpose of the Federal No Surprises Act?
The No Surprises Act will reduce instances where patients face unexpected medical bills due to receiving care from an out-of-network facility or provider during an emergency.
What is the No Surprises Act transition of care?
The No Surprises Act protects continuing care patients in circumstances where their treating provider's or health care facility's plan network status changes, allowing a 90-day transitional care period. During this time: Health plans and issuers must limit cost-sharing to in-network terms.
Who enforces no surprise act?
States have primary enforcement authority over health insurance issuers, facilities, and providers (including air ambulance services providers) with respect to the No Surprises Act.
What are the exclusions for the No Surprises Act?
The No Surprises Act Protections Do Not Apply:
Medicaid (including Medicaid managed care plans). Indian Health Service. Veterans Affairs Health Care. The insurance programs that make up TRICARE.
Why am I being charged more than my copay?
Non-Covered Services: Some medical services or prescription medications may not be covered by your insurance plan. If this is the case, you will be responsible for the full cost of the service or medication, which may exceed your copayment.
Does a provider have to tell you they are out-of-network?
Notice-and-consent requirements for when care is provided by out-of-network clinicians at in-network facilities. Physicians are required to make publicly available and to each patient who is enrolled in commercial health coverage, a disclosure regarding the patient protections against balance billing.
Has the No Surprises Act been successful?
Patients were protected from more than 10 million surprise medical bills thanks to reforms in the No Surprises Act, according to a new survey.
What is the penalty for violating the No Surprises Act?
Challenges with the No Surprises Act
Inaccurate provider directories and compliance failures can be grounds for significant fines. The federal government can issue health plans fines of up to $100 per individual impacted by an NSA violation while providers can also be fined up to $10,000 for compliance errors.
Does the No Surprises Act apply to mental health providers?
Behavioral health agencies must know that the No Surprises Act applies to all providers, including therapists. Thanks to the No Surprises Act, behavioral health providers across the country must comply with transparent billing and other provisions as of January 1, 2022.
What are the benefits of the No Surprises Act?
No more surprise medical bills:
Beginning July 1, 2017, California law protects consumers from surprise medical bills when they get non-emergency services, go to an in-network health facility and receive care from an out-of-network provider without their consent.
How many people are affected by surprise billing annually?
Surprise bills can number in the millions each year. Among privately insured patients, an estimated 1 in 5 emergency claims and 1 in 6 in-network hospitalizations include at least one out-of-network bill.
What is the notice required by the No Surprise Act?
The No Surprises Act requires health care providers, facilities, health plans, health insurance issuers and Federal Employees Health Benefits (FEHB) Program carriers to notify consumers about their surprise billing protections.
What is the controversy with the NSA?
The NSA's actions have been a matter of political controversy on several occasions, including its spying on anti–Vietnam War leaders and the agency's participation in economic espionage.
What is the most secretive U.S. agency?
Not being a creation of Congress, the NSA often acts outside of congressional review; it is the most secret of all U.S. intelligence agencies.
Who does the NSA protect?
NSA provides foreign signals intelligence (SIGINT) to our nation's policymakers and military forces. SIGINT plays a vital role in our national security by providing America's leaders with critical information they need to defend our country, save lives, and advance U.S. goals and alliances globally.