No Surprises Act compliance: what providers actually have to do

The balance billing ban, good faith estimates, consent rules, and disclosures, translated from the regulations into a working checklist.

No Surprises Act compliance comes down to four obligations, and most groups are shaky on at least one. This site lays out what the law requires of providers and facilities, where the penalties sit, and the part most compliance checklists skip: the same law that restricts your billing gives you an arbitration process that pays.

All 3.39 million federal IDR disputes published by CMS, 2023 through 2025. Explore the data at idrexplorer.com.

The four obligations

1. The balance billing ban. For emergency services and for out-of-network care at in-network hospitals and ambulatory surgery centers, you may only collect the patient's in-network cost sharing. The rest of your payment comes from the plan, and disputes over that amount go to arbitration, not to the patient.

2. Good faith estimates. Uninsured and self-pay patients must get a written estimate of expected charges, on deadlines tied to when care was scheduled. Blow the estimate by $400 or more and the patient can take the bill to the patient-provider dispute resolution process.

3. Notice and consent, only where allowed. For some scheduled out-of-network care at in-network facilities, a patient can waive protections by signing the standard notice at least 72 hours ahead. For emergency services and ancillary specialties, consent is never valid, no matter what the patient signs.

4. Disclosures. Providers and facilities must post the standard notice of No Surprises Act protections publicly, put it on their website, and give it to patients they balance-bill-protect.

Good faith estimates, on the clock

The deadlines run from scheduling: care scheduled at least 10 business days out requires the estimate within 3 business days of scheduling; care scheduled 3 to 9 business days out requires it within 1 business day; and anyone who asks for an estimate must get one within 3 business days. The estimate must list expected items and services with codes and expected charges. The GFE requirements page has the full breakdown.

When you can and cannot balance bill

The notice-and-consent exception is narrow and the never-waivable list is long: anesthesiology, pathology, radiology, neonatology, assistant surgeons, hospitalists, intensivists, and diagnostic services including lab and imaging can never balance bill protected patients at in-network facilities, with or without a signed form. Emergency care before stabilization is equally untouchable. The consent rules page covers the timing, the standard form, and the traps.

Penalties and enforcement

Providers face civil monetary penalties of up to $10,000 per violation. States are the primary enforcers, with CMS enforcing directly in states that do not act. There is a safe harbor for honest mistakes: withdraw the improper bill and refund the patient with interest within 30 days. Details on the penalties page.

Compliance is the floor. Payment is the fight.

Everything above keeps you out of trouble. It does not get you paid. The same No Surprises Act that bans balance billing gives providers a federal arbitration process for underpaid protected claims, and the published record shows providers win 85.8 percent of decided disputes at a typical award around 4.7 times the qualifying payment amount. If your group absorbs the billing restrictions without working the payment side, you are running half the law. Lido IDR files those disputes for a flat fee per arbitration.