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  • Academy, Surgical Coalition Urge Improvements for New Surprise Billing Regulations

    The Academy is advocating for improvements to the new surprise billing regulations to help patients make informed healthcare decisions while minimizing administrative burdens on physician practices. We joined more than a dozen other surgical society members of the Surgical Coalition last week in submitting formal comments on an interim final rule setting surprise billing requirements released by the Biden administration in July.

    The Surgical Coalition pressed for clarity about how the new requirements will affect our members and their patients. Our comments focused on issues including what counts as “post-stabilization services” — a definition that affects how broadly the regulations apply.

    We also weighed in on the requirements for cost notification and patient consent and urged the Biden administration to make additional process improvements to ensure patients get the information they need to make informed decisions without placing unnecessary administrative burdens on physician practices.

    The interim final rule implements certain provisions of the No Surprises Act, which was signed into law in December 2020. Congress passed the act to address unexpected gaps in insurance coverage that result in surprise medical bills when patients unknowingly obtain medical services from physicians and other providers outside their health insurance network.

    The interim final rule implements the first of several requirements of the act, including:

    • Banning surprise billing for emergency services
    • Banning high out-of-network cost-sharing for emergency and nonemergency services
    • Banning out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances
    • Banning other out-of-network charges without advance notice

    The regulations will take effect for health care providers and facilities Jan. 1. For group health plans, health insurance issuers and Federal Employees Health Benefits Program carriers, the provisions will take effect for plan, policy or contract years beginning on or after Jan. 1.

    This rule is the first of several regulations that the Administration will be issuing to implement the act in January. We expect regulations on the Independent Dispute Resolution (IDR) process, price comparison tools and certain transparency requirements later this year.