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Quizzes > Quizzes for Business > Healthcare

Master the No Surprises Act Compliance Quiz

Assess Your Understanding of Surprise Billing Rules

Difficulty: Moderate
Questions: 20
Learning OutcomesStudy Material
Colorful paper art illustrating a quiz on No Surprises Act Compliance

With this No Surprises Act Compliance Quiz, healthcare billing specialists and compliance officers can test their grasp of surprise medical billing rules and patient billing transparency. Joanna Weib invites you to explore realistic scenarios and refine your compliance strategies for healthcare billing. Participants will gain confidence in applying dispute resolution guidelines and understanding regulatory nuances. This practice quiz is freely modifiable in the editor to suit training goals. You might also enjoy our Compliance Knowledge Assessment and Employee Compliance Knowledge Quiz, or browse more quizzes to sharpen your regulatory skills.

What is the primary objective of the No Surprises Act?
To eliminate all patient cost-sharing for elective services
To prevent unexpected out-of-network medical bills without proper notice
To require insurers to cover all services regardless of network status
To cap provider reimbursements at Medicare rates
The No Surprises Act is designed to protect patients from unexpected out-of-network bills for certain services when they have not been given proper notice. It does not eliminate cost-sharing entirely or mandate coverage of all services. Its focus is on surprise billing protection.
When did the protections under the No Surprises Act officially take effect?
January 1, 2020
January 1, 2021
January 1, 2022
January 1, 2023
The No Surprises Act's key provisions, including patient billing protections against surprise out-of-network charges, took effect on January 1, 2022. Earlier dates do not reflect when the law became enforceable.
Which scenario best describes a "surprise" medical bill under the Act?
An in-network patient sees an in-network provider at an in-network facility
A patient sees an out-of-network anesthesiologist at an in-network hospital without prior notice
A patient chooses an out-of-network provider for elective surgery with full disclosure
An uninsured patient negotiates a cash price for services
A surprise bill occurs when a patient unknowingly receives out-of-network services, such as an out-of-network anesthesiologist at an in-network hospital, without prior notice and consent. Elective out-of-network care with notice is not a surprise bill.
Which of the following healthcare settings is covered by the Act's surprise billing protections?
Urgent care centers only
In-network emergency departments and facilities for ancillary services
All outpatient physician offices regardless of network status
Retail health clinics
The Act protects patients receiving emergency services in all facilities and ancillary services (like radiology or anesthesia) at in-network facilities. It does not broadly apply to all outpatient offices or retail clinics in the same way.
Under the No Surprises Act, insurers must limit patient cost-sharing to which rate for surprise services?
The provider's billed charge
The plan's usual in-network rate
Medicare reimbursement rate
The highest state Medicaid rate
For surprise services, the patient's cost-sharing is capped at the in-network rate that applies under their plan. This prevents higher out-of-network cost-sharing amounts from surprising the patient.
A patient receives emergency care from an out-of-network physician at an in-network hospital. What amount can the patient be billed?
Full out-of-network charge
No charge
In-network cost-sharing amount only
50% of the out-of-network rate
Under the Act, patients are only responsible for in-network cost-sharing when they receive emergency services from out-of-network providers. Providers cannot balance bill beyond that amount.
Which of the following is required for a good faith estimate provided to an uninsured or self-pay patient?
Estimated charges only for facility fees
Itemized list of expected charges, including provider fees and facility fees
A generic range of potential costs without details
Only the insurer's expected payment
Good faith estimates must itemize expected charges, covering both facility and provider fees. This transparency requirement helps uninsured or self-pay patients understand potential costs.
Which notice must a provider give a patient at least 72 hours before scheduled out-of-network care to avoid surprise billing protections?
Notice of eligibility for advanced payments
Ancillary service consent form
Notice and consent for out-of-network charges
Medicare secondary payer form
To bill an out-of-network rate knowingly, providers must give patients a notice and consent form at least 72 hours before scheduled services. This removes the protections against surprise billing for those services.
Under the No Surprises Act, what is the Qualified Payment Amount (QPA)?
The insurer's highest negotiated rate
The median in-network rate for the same service
75th percentile of out-of-network charges
Average Medicare rate
The QPA is defined as the plan's median in-network contracted rate for the same or similar service in the geographic area. It is the benchmark for cost-sharing and dispute resolution.
Which agency enforces penalties for noncompliance with the No Surprises Act?
Federal Trade Commission
Centers for Medicare & Medicaid Services (CMS)
Office of the Inspector General (OIG)
National Labor Relations Board
CMS is responsible for enforcement of the No Surprises Act, including administering penalties for violations by providers and plans. Other agencies are not charged with these specific penalties.
In the independent dispute resolution (IDR) process, what is the standard for choosing between offers?
Higher billed charge
Offer closest to the QPA
Lower out-of-network rate
Both parties must split the difference
IDR uses a "baseball arbitration" method where the arbiter chooses the offer closest to the QPA without splitting the difference or considering other offers. This incentivizes reasonable initial offers.
Which type of services are explicitly excluded from surprise billing protections?
Emergency department services
Ground ambulance services
Anesthesia services
Radiology services
Ground ambulance services are excluded from the Act's surprise billing protections, though air ambulance services are covered. Other listed services receive protection when they meet surprise billing criteria.
A plan and a provider disagree on payment amount for a surprise bill. How long do they have to negotiate before IDR?
10 days
15 days
30 days
60 days
Parties have a 30-day open negotiation period after the initial payment or notice of denial before either can initiate the IDR process. This timeframe encourages resolution without arbitration.
Which of the following is a key requirement of patient billing transparency under the Act?
Providers must publish their out-of-network rates online
Insurers must send an advanced EOB for emergency services
Patients must receive an itemized bill within 7 days
Facilities must disclose total costs upon discharge only
Insurers must provide an advanced explanation of benefits (EOB) for emergency services, ensuring patients know cost-sharing amounts before receiving surprise bills. The other options are not specified in the Act.
Which factors are permitted for an IDR arbiter to consider beyond the QPA?
Provider's financial need
Market share of the provider
Complexity of services and patient condition
Billed charges only
Arbiters can consider factors like service complexity and patient acuity, in addition to the QPA. They cannot base decisions solely on billed charges or provider finances.
An uninsured patient schedules outpatient surgery. Under the No Surprises Act, when must the provider give a good faith estimate?
At least 10 business days before service
Within 3 business days of scheduling
Only after the service is completed
Within 1 business hour of arrival
Providers must issue a good faith estimate within 3 business days of scheduling services for uninsured or self-pay patients. This ensures patients understand potential costs before care.
Which of these services is NOT covered by the surprise billing protections of the No Surprises Act?
Ancillary services at in-network hospitals
Emergency services at out-of-network hospitals
Ground ambulance transports
Air ambulance transports
Ground ambulance transports are specifically excluded from the Act's protections, although air ambulance services are included. Ancillary and emergency services generally are covered.
How is the Qualified Payment Amount (QPA) calculated for services that lack adequate in-network data?
Use Medicare rate as default
Apply state average in-network rate
Plan must use reasonable proxies or historical data
Take highest prior payment rate
When insufficient in-network data exists, plans must use reasonable proxies or historical information to establish a QPA. This maintains a fair benchmark for payment.
Under the No Surprises Act, what is the penalty for willful failure to provide a good faith estimate?
$1,000 per violation
$10,000 per violation
$41,484 per violation
$100,000 per provider annually
The penalty for knowingly failing to provide a required good faith estimate can reach $41,484 per violation, as updated for inflation. Lesser amounts apply for other types of violations.
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Learning Outcomes

  1. Analyze key provisions of the No Surprises Act
  2. Identify patient billing transparency requirements
  3. Apply compliance strategies to healthcare billing
  4. Evaluate scenarios to distinguish covered services
  5. Demonstrate knowledge of dispute resolution processes

Cheat Sheet

  1. Know the No Surprises Act safeguards - Dive into how the NSA shields patients from surprise medical bills by banning balance billing on many out-of-network charges. This law ensures you won't get hit with unexpected costs for emergency care or certain services at in-network facilities. Learn exactly which services are covered and where exceptions apply. No Surprises Act - Mayo Clinic
    2. No Surprises Act - Mayo Clinic
  2. Master billing transparency requirements - Discover how providers must deliver a "good faith estimate" of costs to uninsured or self-pay patients before any work begins. This upfront estimate gives you a crystal-clear picture of expected charges so you can budget wisely. Get the scoop on timing, content and delivery rules. No Surprises Act | CMS
    3. No Surprises Act | CMS
  3. Build rock-solid compliance strategies - Learn best practices for setting up clear communication protocols and updating your billing software to meet NSA requirements. From staff training to automated alerts, these tweaks keep you in the clear and your patients worry-free. Walk through easy steps to audit and refine your billing workflows. Implementation of the No Surprises Act | American Medical Association
    4. Implementation of the No Surprises Act | American Medical Association
  4. Spot covered vs. non-covered services - Play detective with real-world scenarios to pinpoint when balance billing is off-limits (like emergency care) and when exceptions kick in. You'll learn to flag out-of-network providers in in-network facilities and avoid billing slip-ups. Practice makes perfect! No Surprises Act - Mayo Clinic
    5. No Surprises Act - Mayo Clinic
  5. Tackle dispute resolution head-on - Understand the 30-day open negotiation window where providers and insurers can haggle over payment. If talks stall, dive into the Independent Dispute Resolution (IDR) process to settle disagreements fairly. We'll break down paperwork, deadlines and key players. NSA Independent Dispute Resolution Process | CMS
    6. NSA Independent Dispute Resolution Process | CMS
  6. Decode the Qualifying Payment Amount (QPA) - The QPA is your North Star in the IDR process, based on an insurer's median in-network rate for similar services. Knowing how it's calculated helps you argue for fair payments and spot potential under-payments. We'll show you how to crunch the numbers step by step. Providers Challenge Payments in IDR | Health Affairs
    7. Providers Challenge Payments in IDR | Health Affairs
  7. Leverage state-level balance billing laws - Some states go above and beyond the federal NSA, offering extra protections or unique dispute paths. Explore how your state's rules stack up and when they override or complement the federal law. Stay ahead of the curve and maximize patient safeguards. No Surprises Act - Mayo Clinic
    8. No Surprises Act - Mayo Clinic
  8. Steer clear of non-compliance penalties - Slip-ups can cost you big - think hefty fines and enforcement actions from federal agencies. We'll highlight common pitfalls and offer tips to keep you audit-ready. Protect your practice and reputation with these must-know compliance checkpoints. No Surprises Act | CMS
    9. No Surprises Act | CMS
  9. Nail down balance billing exceptions - When can providers legally balance bill? Understand the iron-clad "informed consent" exception and other niche cases where patients agree to out-of-network rates. You'll learn the exact language and paperwork needed to avoid legal headaches. Implementation of the No Surprises Act | American Medical Association
    10. Implementation of the No Surprises Act | American Medical Association
  10. Grasp the NSA's ripple effects - From happier patients to streamlined provider-insurer relationships, the NSA reshapes the entire billing landscape. Explore how different stakeholders win - and where new challenges may arise. This big-picture view helps you adapt strategies for success. Understanding the No Surprises Act | Brookings
    11. Understanding the No Surprises Act | Brookings
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