October 1, 2021
  • HHS issued an interim final rule that outlines how dispute resolution regarding surprise billing should work between out-of-network providers and insurers. The rule states that payers and providers must start with a 30-day “open negotiation” to determine a payment rate, If that fails, they can go to arbitration where an arbitrator will calculate with a price using what the insurer pays other providers for the same service in the same area as a guide. The rule also requires providers and hospitals to give a “good faith estimate” to uninsured patients. While insurers are encouraged by the rule, hospitals are not. (Press release here; Articles here, here, here, here, and here)