Medicare Compliance & Reimbursement - 2021 Issue 10
Billing: Be Ready for Balance Billing Changes Before 2022
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Article Overview
This article explains upcoming federal balance billing and surprise billing requirements taking effect in 2022. It is aimed at providers, facilities, air ambulance services, health plans, and billing staff who need to understand the new disclosure, notice, complaint, and compliance expectations under the interim final rule and related federal legislation. The discussion stays focused on the regulatory changes, affected parties, and preparation steps rather than detailed coding guidance.
Why This Topic Matters
The article helps healthcare organizations prepare for patient billing transparency requirements, changing out-of-network billing restrictions, and related administrative workflows before the January 1, 2022 effective date.
Article Sections
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Hospitals, Air Ambulances Face the Most Changes
Discusses the main provider and facility categories affected by the new balance billing framework. It also summarizes the broad areas of care and service settings most likely to be impacted.
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Balance Billing Still an Option in Some Circumstances
Covers the general situations in which balance billing may still be permitted under federal rules and the types of organizations covered by the changes. It also notes the availability of model disclosure materials and the comment process.
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Patients Can Lodge Complaints
Describes the complaint framework for patients and the federal agencies involved in handling enforcement-related issues. It also notes that certain implementation details were still being finalized.
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Prep for the Adjustment Now
Focuses on operational preparation for the new requirements, including payer relationship review, patient communication readiness, and website disclosure planning. It also mentions anticipated follow-up regulations.
What You Will Learn
- Which organizations and service settings are affected by the balance billing changes
- What types of compliance and disclosure preparation may be needed before the effective date
- How the new federal framework relates to patient complaints and administrative oversight
- What broad operational areas providers and plans should review in advance
Who Should Read This
- Healthcare providers
- Hospital billing departments
- Emergency department staff
- Air ambulance services
- Health plans and insurers
- Revenue cycle and compliance professionals
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