First Rule on ‘Surprise’ Billing Lays Out How Hospitals Get Paid

The first regulation to implement a law that prohibits hospitals and doctors from billing sending patients high bills in emergencies and other situations was released Thursday by the Biden administration.

The interim final rule (RIN 0938-AU63) specifies how rates will be calculated to determine what providers should be paid.

The No Surprises Act, passed as part of appropriations legislation (H.R. 133) in December 2020, bars health providers from billing patients more than would be paid for in-network services in emergencies or other circumstances when out-of-network clinicians are used.

How much hospitals and doctors are paid for out-of-network care ...