No Surprises Act
Federal law effective January 1, 2022 that protects patients from surprise balance bills in emergency and certain facility-based settings.
Updated
The No Surprises Act is a federal law that took effect January 1, 2022, protecting patients with job-based or individual market coverage from surprise balance bills for emergency services and for non-emergency services furnished by out-of-network providers at in-network facilities.
The law generally prohibits out-of-network providers from balance billing patients in protected situations and establishes an independent dispute resolution process for providers and payers to settle payment disagreements.
In practice
Billing teams must apply No Surprises Act protections to applicable claims, issue required patient notices, and route disputed amounts to the federal independent dispute resolution process rather than pursuing collection from the patient. The law also requires Good Faith Estimates for uninsured and self-pay patients.
Commonly confused with
- Balance billing: Balance billing is the practice; the No Surprises Act is the law that restricts that practice in defined situations.
- Good Faith Estimate: A Good Faith Estimate is a patient-facing estimate required under the No Surprises Act, not the law itself.