2022 Surprise Billing Requirements | February 2022-Overview of Public Health Service (PHS) Act Provider And Facility Requirements

Overview of Public Health Service (PHS) Act Provider And Facility Requirements

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The Public Health Service (PHS) Act has established new requirements for providers, facilities, and providers of air ambulance services, which will come into effect on January 1, 2022. These requirements include prohibiting balance billing for out-of-network emergency services, non-emergency services by nonparticipating providers at certain participating healthcare facilities, and air ambulance services by nonparticipating air ambulance providers. Providers and facilities are also required to disclose patient protections against balance billing and provide a good faith estimate of expected charges to uninsured individuals. In cases where a provider's network status changes, they must ensure continuity of care for patients. Additionally, providers and facilities must improve provider directories and reimburse enrollees for errors. <br /><br />It is important to note that these requirements do not apply to beneficiaries or enrollees in federal programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE, as these programs have their own protections against high medical bills. <br /><br />Enforcement of these requirements will be carried out by CMS, and a list of provisions that will be enforced will be published by state. <br /><br />Resources and guidance materials are available to help providers and facilities understand and comply with these requirements. Definitions of key terms, such as emergency services, nonparticipating providers, and participating health care facilities, are also provided. Any questions about the requirements and enforcement can be sent to provider_enforcement@cms.hhs.gov.

Keywords

Public Health Service Act

balance billing

emergency services

nonparticipating providers

participating healthcare facilities

air ambulance services

patient protections

good faith estimate

network status

enforcement of requirements