The No Surprises Act: Updates and Critical Information for Your Practice (Sponsored by Gottlieb & Greenspan) | Insights from Industry-The No Surprises Act: Updates and Critical Information for Your Practice (Sponsored by Gottlieb & Greenspan)

Video Transcription

Video Summary

The webinar, presented by James Greenspan of Gottlieb & Greenspan Law, provides a comprehensive update on the No Surprises Act (NSA) effective January 1, 2022, which addresses unexpected out-of-network medical bills for emergency and certain non-emergency services at in-network facilities. Greenspan, an experienced litigator in no-fault and workers’ compensation cases, highlights the complexities and ongoing challenges around NSA implementation and arbitration processes.<br /><br />The NSA covers emergency and surprise bills as well as scheduled procedures if patients did not sign required consent forms. It primarily applies to commercial health plans (e.g., UnitedHealthcare, Cigna) but excludes Medicare, Medicaid, and plans with existing fee schedules or hold harmless clauses. States with their own surprise bill laws (e.g., New York, New Jersey) coexist with the federal NSA, often dividing jurisdiction based on plan type (fully insured vs. self-funded) and geography, leading to complex eligibility questions.<br /><br />Greenspan discusses the arbitration workflow and strict timelines: providers have 30 business days to initiate open negotiations after receiving an Explanation of Benefits (EOB) and only 4 business days to file for arbitration if unresolved. Cases may be filed as single-code or batch claims, with single-code filings often yielding better recoveries. Arbitration uses “baseball-style” decisions where the arbiter picks either party’s final offer.<br /><br />Despite millions of cases filed and a high provider win rate (~82-84%), challenges remain including lack of transparency, inconsistent arbitrator decisions, delayed carrier payments, and ongoing carrier objections citing CMS “technical assistance.” Legal uncertainties persist over providers’ ability to sue carriers for nonpayment under the NSA, although alternative claims like unjust enrichment are being pursued.<br /><br />Greenspan advises providers to be vigilant with deadlines, carefully manage arbitration entity selection to avoid dismissals, and submit comprehensive supporting evidence. He urges provider advocacy to pressure CMS and Congress to enforce timely payments, noting pending legislation that would impose interest and penalties on carriers for delayed arbitration awards. Overall, while the NSA protects patients and allows providers to recover more than previously possible, the system is still maturing with significant operational and enforcement hurdles to resolve.

Keywords

No Surprises Act

NSA implementation

out-of-network medical bills

arbitration process

emergency services billing

commercial health plans

provider arbitration deadlines

baseball-style arbitration

CMS enforcement challenges

provider advocacy