Column | Legal and Regulatory Compliance
Hospitals, physicians and long-term care and ancillary service providers can anticipate significant changes in the regulatory climate in 2022. Although such changes are predictable, context is key: Regulatory policymaking in healthcare in t...
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Column | Legal and Regulatory Compliance
The No Surprises Act, which became effective on Jan. 1 of 2022, will clearly benefit patients, .ut its larger impact is yet to be seen as the industry awaits the release of provisions targeting health plans and payers.
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Fact Sheet | Legal and Regulatory Compliance
HFMA presents a detailed Summary of the OIG’s federal anti-kickback statute and civil monetary penalty final rule, published in the December 2, 2020, Federal Register.
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No Surprises Act

As a result of the 2021 Consolidated Appropriations Act, several No Surprises Billing Act regulations will go into effect on Jan. 1, 2022 for providers, facilities and air ambulance services. 

HFMA has made it a priority to work closely with stakeholders, industry partners and members to help them navigate and prepare for the No Surprises Act regulations that will continue to be phased in throughout 2022 and beyond. 

Join the No Surprises Act Forum to connect with peers, exchange resources and discuss implementation challenges.

HFMA Resources

Fact Sheet | Payment Reimbursement and Managed Care

Requirements Related to Surprise Billing Part I Summary of Interim Final Rule with Comment

HFMA presents a detailed summary of the interim final rules with comment period that amend and add to existing regulations to implement provisions of the No Surprises Act enacted as part of the Consolidated Appropriations Act, 2021.

Fact Sheet | Payment Reimbursement and Managed Care

Requirements Related to Surprise Billing, Part II Summary of Interim Final Rule with Comment

HFMA presents a detailed summary of the interim final rule with comment period building on regulations issued in the July 2021 IFC to implement provisions of the No Surprises Act.

How To | Consumerism

Consumer Educational Guide

These guides are designed to help consumers understand their healthcare out-of-pocket costs and obtain price estimates.

News | Medicare Payment and Reimbursement

Senate panel discusses ways to address Medicare financing — and the consequences of not acting

Medicare Part D and Medicare Advantage could be prime targets as Congress seeks to shore up the Hospital Insurance Trust Fund before it becomes insolvent in 2026 as projected.

Column | Legal and Regulatory Compliance

Shawn Stack: No Surprises Act is important move toward meaningful consumer transparency

The No Surprises Act, which became effective on Jan. 1 of 2022, will clearly benefit patients, .ut its larger impact is yet to be seen as the industry awaits the release of provisions targeting health plans and payers.

Blog | Coronavirus

HHS's Office of Inspector General announces audit of providers’ COVID-19 billing practices

OIG has announced an audit of Provider Relief Fund recipients to ensure they did not balance-bill presumptive or actual COVID-19 patients.

News | Patient Financial Communications

New surprise billing regulations: How providers should be preparing to fulfill the pending requirement about good-faith estimates

Providers have had a mere three months to implement the processes needed to comply with a new requirement to provide uninsured patients with good-faith estimates in advance of services.

News | Health Plan Payment and Reimbursement

Hospitals, physicians file lawsuit over the arbitration process in the new surprise billing regulations

Leading provider associations have asked a federal court to halt the incorporation of criteria that appear to favor insurers over providers in an arbitration process to determine out-of-network payment amounts.

Blog | Patient Financial Communications

CMS makes templates available to help with aspects of the new surprise billing regulations

CMS has published templates and resources that can guide healthcare providers in implementing some of the surprise-billing requirements that take effect in January.

Blog | Billing and Collections

A closer look at the new surprise billing regulations: How cost sharing will be calculated

The qualifying payment amount that establishes a patient's cost sharing for out-of-network care also is intended to factor into negotiations between providers and health plans regarding payment.

News | Health Plan Payment and Reimbursement

The finalized arbitration process in new surprise-billing regulations appears to favor insurers over hospitals

A new rule establishes a process for resolving payment disputes between health plans and hospitals when regulations on surprise billing begin in 2022.

News | Billing and Collections

Government agencies issue the first set of regulations restricting surprise billing

In a development that many healthcare stakeholders have awaited for months, four federal agencies on Thursday, July 1 released new regulations prohibiting surprise billing in many scenarios.

News | Billing and Collections

Healthcare providers face challenges implementing the latest Surprise Medical Billing Interim Final Rule

HFMA’s Shawn Stack reviews the key provider challenges introduced by the IFC interim final rule with comment period (IFC) that implements sections of the federal ban on surprise medical bills.

Podcast | Patient Experience

Patients have access to more information than ever. How should we be talking to them about it?

The Information Blocking Final Rule from the 21st Century Cures Act and federal transparency initiatives like the No Surprises Act have given patients more access to information than they’ve ever had before. On this episode, Terry Hush, CEO of Roji Health Intelligence, discussed how that access should change the conversations providers are having with their patients.

Podcast | Billing and Collections

How providers should prepare for No Surprises deadlines

Nick Hut talks with John Friedel from Abeo about the No Surprises Act and what providers should be doing now to prepare.