Follow this helpful flow chart to see whether the No Surprises Act Balance Billing Protections applies to your office and your patients.
The NSA rules on non-emergency services apply only to services performed by an out of network DC at an in-network hospital or Ambulatory Surgery Center (ASC). A provider is not permitted to obtain the patients’ consent to give up their balance billing protections for certain services. If an out-of-network provider performs the following services at an in-network hospital or ASC, the provider will always be limited to collecting the in-network cost-sharing and may not balance bill if any of the following apply: Services related to emergency medicine, anesthesiology, pathology, radiology and neonatology, whether provided by a physician or non-physician practitioner; Services provided by assistant surgeons, hospitalists and intensivists; Diagnostic services, including radiology and laboratory services; Items and services provided by a nonparticipating provider if there is no participating provider who can furnish such item or service at such facility; Items or services furnished as a result of unforeseen, urgent medical needs that arise at the time an item or service is furnished, regardless of whether the provider previously obtained consent to balance bill.