The promotion of patient billing protections through price transparency and limits on surprise billing are now central features of the Centers for Medicare & Medicaid Services’ (CMS) health policy agenda. On January 1, 2021, the agency’s Price Transparency Rule for hospitals went into effect, and CMS is now focusing on enforcement of its Price Transparency Rule. On December 27, 2020, Congress enacted the No Surprises Act to protect patients who receive out-of-network emergency care or non-emergency care from an in-network facility from surprise bills from out-of-network professional providers, and CMS issued its first set of rules to implement that statute on July 1, 2021. The No Surprises Act also requires a prompt response given the January 1, 2022 implementation date.

This new legal regime is here to stay, and it presents a series of multi-faceted challenges for providers in their interactions not only with state and federal regulators, but also with payers and with the public. In response, King & Spalding established the Surprise Billing and Price Transparency Working Group, which is a tailored package of legal services to assist our clients in developing solutions to these challenges and mitigating the legal and regulatory burden of the new requirements.

The Working Group’s proprietary portal is available to members here. For more information, interested parties can contact Mark Polston, Jim Boswell, Joel McElvain, Chris Kenny, Amanda Hayes-Kibreab, Glenn Solomon, or John Barnes.

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