The No Surprises Act, passed in December 2020, may intersect with the new price transparency regulations to impact contract negotiations between payers and providers.
The No Surprises bill limits the amount patients pay for out-of-network services to their cost-sharing amounts had the services been in network. The only exception for which a provider can bill more than the cost-sharing amount is if the patient receives out-of-network nonemergency services with advance notice that the service is out of network and consents to that service with a higher bill.
Hospitals should monitor CMS rulemaking and may need to consider changes to how they are reporting charge information and prepare to comply with the No Surprise Bill Act requirements, which would be effective January 1, 2022.
Important proposed changes for the Price Transparency Rule
- Hospitals must guarantee accessibility of price information without barriers such as BLOCKING CODES (CAPTCHA), AGREEMENTS TO TERMS AND CONDITIONS, or SUBMISSION OF CONSUMER’S PERSONAL INFORMATION.
- Price estimator tools may not meet the criteria outlined in the CMS regulation.
- Increase penalties for noncompliance up to $5,500 PER DAY or $2,007,500 FOR FULL CALENDAR YEAR.
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