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CMS Releases FAQ for No Surprises Act

The Centers for Medicare and Medicaid Services (“CMS”) released a new Frequently Asked Questions (“FAQ”) worksheet covering the balance billing and notice and consent requirements for the federal No Surprises Act.

The No Surprises Act lays out the federal prohibition against certain non-participating providers and healthcare facilities balance billing patients outside of their applicable cost-sharing amounts for certain emergency and non-emergency healthcare services. The FAQ details the requirements for providers along with the rights of patients with a focus on the notice and consent criteria specified under the No Surprises Act.

Given the broad implications on both providers and patients alike under the No Surprises Act, CMS’s FAQ serves to clarify some, but not all, facets of the No Surprises Act and provides answers for some of the frequently asked questions that have arisen since its implementation.

CMS Issues 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule

CMS released the 2023 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule, 87 FR 44502, on July 15, 2022. The proposed rule would increase Medicare outpatient payment rates by 2.7% for next year for ambulatory surgical centers (“ASC”) that meet applicable quality reporting requirements. According to CMS, this update is based on the projected hospital market basket percentage increase of 3.1%, reduced by 0.4 percentage point for the productivity adjustment.

The proposed rule also proposes updates and refines the requirements for the Hospital Outpatient Quality Reporting ("OQR") Program, the ASC Quality Reporting ("ASCQR") Program, and the Rural Emergency Hospital Quality Reporting ("REH") Program. Among other things, the proposed rule will also remove 10 services from the inpatient-only list, and add a lymph node biopsy or excision procedure to the ASC covered-procedure list.

CMS additionally proposes to add a new Medicare provider type called “Rural Emergency Hospitals” (“REH”) effective January 1, 2023. In the proposed rule, CMS is also proposing updates to the physician self-referral law for the new REH provider type which will include: (1) a new exception for ownership or investment interests in an REH; and (2) revisions to certain existing exceptions to make them applicable to compensation arrangements to which an REH is a party.

CMS issued a Fact Sheet for the proposed rule here.