ANSWERS · COMPLIANCE

What is the No Surprises Act and how does it affect my practice?

The No Surprises Act limits balance-billing for certain out-of-network and emergency care and requires good-faith estimates for uninsured and self-pay patients. For most independent practices, the practical impact is the good-faith-estimate workflow plus the out-of-network dispute (IDR) process for the situations it covers.

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What actually matters

  • Uninsured and self-pay patients must get a good-faith estimate of expected charges
  • Surprise balance-billing is restricted for certain out-of-network and emergency situations
  • An Independent Dispute Resolution (IDR) process exists for OON payment disputes
  • There are provider disclosure requirements about balance-billing rights
  • For most practices the real lift is the good-faith-estimate process

Common questions

Does the No Surprises Act apply to my in-network claims?

Its balance-billing limits mainly target out-of-network and emergency scenarios. The good-faith-estimate duty applies to uninsured and self-pay patients more broadly.

Where Volari fits: For out-of-network underpayments, the Act's IDR process is one more lever to challenge a claim that paid below fair value.

Related answers
How do I lower my practice's denial rate?How do I reduce days in A/R?How do I know if I'm being underpaid by insurers?In-house billing vs. outsourcing: which is right for my practice?How do I renegotiate payer contracts for better rates?How do I fix my prior-authorization workflow?

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