Surprise billing legislation – A small win for providers with big revenue cycle process changes

Thursday, February 25th, 2021 | 10:30 am - 11:30 am CT

Congress in 2020 passed revised “Out-of-Network” billing requirements — a compromise that meets both provider and patient needs. The law provides improved payment opportunities for most providers than previous regulations that were considered and will protect patients from surprise billing for:

  • Emergency services by out-of-network providers or facilities, including emergency air transport
  • Non-emergency services provided by out-of-network physicians in network facilities for which patients do not consent.

This discussion will cover regulatory requirements and will focus on how physicians and hospitals should prepare for new billing and payment guidelines that take effect Jan. 1, 2022:

A few highlights:

  • Patient cost will be limited to cost-sharing amounts that apply to in-network services, and the amount patients pay will meet their in-network annual deductible.
  • The regulation requires out-of-network service providers to give patients 72-hour notice of their estimated charges. Patients must agree to receive out-of-network care for the hospital or physician to bill and expect payment of full charges.
  • The legislation relies on voluntary negotiations between insurers and providers, backed up by arbitration if negotiations fail.
  • The small win for providers relates to the legislation omitting Medicaid and Medicaid reimbursement rates during arbitration.
  • For states with laws already in place, the requirements defer to state rules on establishing payment amounts, even if the state has a payment standard. 



Mike Morris - Emma Goodman

Mike Morris

President & CEO, Xtend Healthcare

Linda Corley - Emma Goodman

Linda Corley

Chief Compliance Officer, Xtend Healthcare