Surprise Billing and Patient Notice

Breaking Down Federal & State Surprise Billing Requirements for Massachusetts Physicians

In the final days of 2020, both Congress and the Massachusetts legislature passed laws related to surprise or out-of-network billing and related requirements for notice and disclosure for patients regarding network status and price transparency. The federal “No Surprises Act”, as detailed in resources below, establishes a comprehensive statutory framework, including a ban on surprise billing, creation of an independent dispute resolution process, and patient notice and disclosure provisions. Provisions contained in the Massachusetts Patients First Act (Section 25 of Chapter 260 of the Acts of 2020), as detailed in the Massachusetts Department of Public Health (MDPH) bulletin below, similarly impose provider responsibilities for patient notice and disclosure regarding network status and price transparency.

The Medical Society has been actively engaged on these issues, working with the state Department of Public Health and congressional stakeholders to understand this complex landscape and reconcile the competing obligations under both laws. Our advocacy, together with the Massachusetts Health & Hospital Association, has resulted in the notable delay in implementation and enforcement of penalties for the violation of the state notice provisions by the MDPH until July 31, 2022. During this time, the MMS will continue to work with key health care stakeholders, the MDPH, and legislative and congressional members to establish a clear understanding of provider responsibilities under both state and federal law and to pursue necessary changes to ensure a smooth implementation of the concurrent laws.

Massachusetts Medical Society Resources

• In December 2021, the MMS along with the Massachusetts Health & Hospital Association held a webinar providing an overview of physician responsibilities under both the NSA and the Patients First Act. A recording of the webinar is available here and slides from the presentation are available here.
• MMS Practice Guides:
  • High Level Overview of Primary NSA Requirements
  • MMS Practice Guide for Surprise Billing and Patient Notice  (.pdf)

Massachusetts Patients First Act Resources

• Department of Public Health Resources
  • Notice to Providers on Patients First Law
  • Notice to Patients on Patients First Law

Federal No Surprises Act Resources

• American Medical Association Resources
  • AMA NSA Landing Page
  • AMA Toolkit for Physicians: Preparing for Implementation of the No Surprises Act
  • AMA Guide for Physicians: Disputing Out-of-Network Payments Using the No Surprises Act Independent Dispute Resolution Process
• Centers for Medicare & Medicaid Services (CMS) Provider Resources
  • CMS Main Landing Page for “No Surprises Act” Resources
  • Summary of Provider Requirements
  • Overview of Rules and Fact Sheets
    *Includes model disclosures and standardized forms for patient notice and consent and good faith estimates
  • Information about the Independent Dispute Resolution Process
  • CMS No Surprises Help Desk or call 1-800-985-3059

This information included and linked to on this page is intended to serve as a general resource and guide. It is not to be construed as legal advice. Attorneys with knowledge of the surprise billing and price transparency laws should be consulted regarding the application of these laws to specific situations.