Surprise Medical Billing Interim Final Rule

On July 1st, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (Tri-Agencies), along with the Office of Personnel Management (OPM) released an interim final rule with comment period (IFR) entitled the Requirements Related to Surprise Billing; Part I implementing many of the provisions of the No Surprises Act (NSA) signed into law as part of the Consolidated Appropriations Act, 2021 COVID-19 relief bill. The NSA addresses surprise medical billing at the federal level by holding patients harmless from the costs of out-of-network care in certain situations and creating an Independent Dispute Resolution process for determining provider payments. These situations include emergency services, air ambulance services provided by out-of-network providers, and non-emergency services provided by out-of-network providers at in-network facilities in certain circumstances. The law also addresses price transparency, provider directories, and other patient protections.


The IFR clarifies the Qualified Payment Amount (QPA) by specifying cost sharing calculations for emergency services provided by out-of-network emergency facilities and out-of-network providers, and certain non-emergency services furnished by out-of-network providers at certain in-network facilities. In addition, the IFR clarifies certain notice and consent requirements for health care providers and facilities. The American Medical Association (AMA) is closely reviewing the IFR after submitting comments to the Tri-Agencies on the implementation and calculation of the QPA and the QPA audit process, amongst other provisions, as well as comments on the Independent Dispute Resolution Process and will provide a detailed summary in the coming days. For more information, see CMS’ interim final rule fact sheet.