Key Ways Providers Can Prepare for New Surprise Billing Rules

The law, the No Surprises Act, was passed in December 2020 as part of the omnibus spending bill and comes as a long-awaited solution for surprise medical bills. The new rules for unexpected out-of-network charges will have major implications for healthcare providers.

The “final-offer” arbitration process represents a significant workflow change for providers and payers, who will each need to make an offer to an independent third party to resolve the surprise billing dispute.

Operational readiness for the surprise billing law includes adding or leveraging analytics capabilities that “drive strategies to avoid balance billing situations,” the report states. Additionally, providers and payers may need to “upskill” their staff to handle new processes and possibly engage external vendors to support the management of arbitration and related administrative functions.