Neil H. Baum, MD, presented “No More Surprises: An Overview of the No Surprises Act​” for the Grand Rounds in Urology audience in October 2021.

How to cite: Baum, Neil H. No More Surprises: An Overview of the No Surprises Act.” October 2021. Accessed Dec 2021.

No More Surprises: An Overview of the No Surprises Act

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, summarizes the rules and implications of the No Surprises Act against unexpected out-of-network medical bills. He defines a surprise medical bill as one where a patient receives an often large bill for the difference between the out-of-network provider’s fee and the amount covered by the patient’s health insurance, and he notes that 2 out of 3 American adults are worried about these bills. Dr. Baum explains that the No Surprises Act, which was signed into law by Congress on December 27, 2020, prohibits out-of-network providers from billing patients more than in-network amounts, and that a violation brings a $10,000 fee per occurrence. He says that this most impacts out-of-network providers, emergency room physicians, and providers that a patient typically does not select, including hospitalists, radiologists, anesthesiologists, and pathologists. Dr. Baum then discusses the process that occurs if a provider disagrees with a payment, noting that the losing party of an Independent Dispute Resolution (IDR) must ultimately pay the cost of the IDR. 

For more commentary on practice management from Dr. Baum, visit his Improving Your Urology Practice page. For more on using EMR templates, check out our original lecture series, Leveraging the Electronic Medical Record to Improve Prostate Cancer Care.