The No Surprises Act requires medical practices to stop balance billing patients in protected situations, give uninsured and self-pay patients a written Good Faith Estimate before scheduled care, and post a plain-language notice explaining patients’ billing protections. In force since January 1, 2022, the law reshaped how independent practices handle out-of-network charges and self-pay pricing.
This guide breaks down exactly what the No Surprises Act demands of a medical practice in 2026, what has changed this year, and the seven steps that turn the rules into a defensible, repeatable compliance process.
What is the No Surprises Act?
The No Surprises Act is a federal law, effective January 1, 2022, that protects insured patients from “surprise” medical bills. Those are the unexpected out-of-network charges that arrive after an emergency, or after care at a facility the patient believed was fully in-network. The law also created new price-transparency duties toward uninsured and self-pay patients. It is enforced jointly by the U.S. Departments of Health and Human Services, Labor, and the Treasury, and it sits on top of any state balance-billing law that already applies to your practice.
For a medical practice, the No Surprises Act is not a billing-vendor problem to outsource and forget. It is a compliance obligation, much like HIPAA, OSHA, and Stark Law and Anti-Kickback compliance, that touches your front desk, your scheduling scripts, your website, and your patient paperwork. It belongs inside your broader medical practice compliance program, not on a shelf.
Who must comply with the No Surprises Act?
Almost every licensed provider and facility that bills patients falls under the No Surprises Act, regardless of specialty or practice size. That includes independent physician practices, group practices, ambulatory surgical centers, imaging and laboratory centers, and hospital-based clinicians. Solo and small practices are not exempt.
If your practice ever treats out-of-network patients, sees patients in a facility setting, or serves uninsured and self-pay patients, the No Surprises Act applies to you. Your payer contracts and network status with each plan determine exactly how.
When can a practice no longer balance bill a patient?
Balance billing means charging a patient the difference between your full charge and what their health plan paid. Under the No Surprises Act, that is prohibited in three protected situations, and the patient owes only their normal in-network cost-sharing.
| Situation | Can you balance bill? | What the patient owes |
|---|---|---|
| Emergency services (including air ambulance), in or out of network | No | In-network cost-sharing only |
| Non-emergency care by an out-of-network provider at an in-network facility | No (unless valid notice-and-consent) | In-network cost-sharing only |
| Post-stabilization services following an emergency | No (unless valid notice-and-consent) | In-network cost-sharing only |
In these situations, your practice must base the patient’s cost-sharing on the plan’s in-network amount and pursue the balance from the health plan rather than the patient. Ground ambulance service is a notable gap the federal law does not yet cover, although a number of states regulate it separately.
What is a Good Faith Estimate, and who needs one?
A Good Faith Estimate is a written, itemized cost estimate a practice must give to uninsured and self-pay patients before scheduled, non-emergency care. “Self-pay” also includes an insured patient who chooses not to run a particular visit through their coverage. The estimate must list the expected charges for the primary service plus the items and services reasonably expected to accompany it, be written in clear and understandable language, and include instructions for disputing a bill that comes in too high.
The deadline depends on how far in advance the service is scheduled:
| When the service is scheduled or requested | Good Faith Estimate deadline |
|---|---|
| At least 10 business days ahead | Within 3 business days of scheduling |
| 3 to 9 business days ahead | Within 1 business day of scheduling |
| Fewer than 3 business days ahead | No written estimate required |
| Any time, on patient request | Within 3 business days of the request |
Important 2026 update: the parallel requirement to send cost estimates for insured patients, known as the “Advanced Explanation of Benefits,” remains deferred. Federal regulators have not begun enforcing it and expect to issue a proposed implementing rule during 2026. Until that rule is finalized, the Good Faith Estimate obligation applies only to uninsured and self-pay patients.
What is the patient-provider dispute resolution process?
If an uninsured or self-pay patient is billed at least $400 more than their Good Faith Estimate for a given provider, they can start the federal patient-provider dispute resolution (PPDR) process. The patient has 120 calendar days from the date of the bill to file.
While a dispute is pending, your practice cannot move the bill to collections, cannot charge late fees, and cannot take any retaliatory action against the patient. Accurate, complete estimates are the best defense, because that $400 cushion disappears quickly when related charges are left off the original estimate.
What disclosure notice must your practice post?
The No Surprises Act requires practices to give patients a one-page notice, in plain language, explaining their protections against surprise billing and balance billing. You must make that notice publicly available, post it on your practice website if you maintain one, and provide it to the patient in connection with the visit. Patients are not required to sign it. Federal regulators publish a model disclosure notice you can adapt, which is the safest way to keep the wording compliant.
How does notice-and-consent work, and when can’t you use it?
In limited non-emergency situations, an out-of-network provider may ask a patient to voluntarily waive their balance-billing protections by signing a written notice-and-consent form. The form must be given at least 72 hours before a scheduled appointment, or at least 3 hours before a same-day appointment, and it must include a good-faith estimate of the out-of-network cost.
Notice-and-consent is deliberately narrow, and it can never be used for certain care. A patient cannot waive their No Surprises Act protections for:
- Emergency services;
- Ancillary services, including anesthesiology, pathology, radiology, laboratory, and neonatology, whether delivered by a physician or a non-physician;
- Care by an out-of-network provider when no in-network provider was available; and
- Unforeseen, urgent medical needs that arise during a visit.
Treating notice-and-consent as a routine form to hand every out-of-network patient is one of the fastest ways to fall out of compliance.
What are the penalties for non-compliance?
Violations of the No Surprises Act can draw a civil monetary penalty of up to $10,000 per violation. The law includes a safe harbor: penalties generally do not apply if a practice did not knowingly violate the rules and could not reasonably have known it was in violation, withdraws the incorrect bill within 30 days, and reimburses the patient for any overpayment plus interest.
In other words, catching and correcting an honest mistake quickly matters, but a repeatable, documented process that prevents the mistake in the first place matters far more.
7 steps to make your practice No Surprises Act compliant
Turning the No Surprises Act from a legal summary into daily practice comes down to seven concrete steps:
- Map where the law touches your practice. List the settings where you see patients, your network status with each payer, and how often you treat out-of-network, self-pay, and uninsured patients. That tells you which No Surprises Act duties actually apply and where the risk concentrates.
- Build a Good Faith Estimate workflow. Create a standard estimate template, assign a clear owner (usually the scheduler or front desk), and wire the timing rules into your scheduling system so estimates go out on deadline every time.
- Post and distribute the disclosure notice. Put the one-page notice on your website, in your intake packet, and at check-in, using the federal model language so nothing is missing.
- Write a compliant notice-and-consent procedure. Document the 72-hour rule, the narrow situations where consent is even allowed, and the ancillary services that can never be waived, then train staff never to use it outside those lines.
- Train the front desk and billing staff. The people who schedule, check in, and bill patients are where compliance succeeds or fails. Give them scripts, a checklist, and a clear escalation path, and fold the training into how you staff and onboard the team.
- Set a dispute-response procedure. Know how to respond to a patient-provider dispute, and understand how the separate federal independent dispute resolution (IDR) process works for disagreements with payers over out-of-network rates.
- Audit at least once a year. The No Surprises Act is still being built out, and the Advanced EOB rule is expected next. Review your estimates, notices, and consent forms annually and after any rule change, and track compliance as an operational metric.
How Practice Management Consultancy helps practices stay compliant
No Surprises Act compliance is exactly the kind of operational, cross-departmental work that independent practices struggle to build alone. Practice Management Consultancy works with medical practices to turn the rules into working systems: Good Faith Estimate templates and workflows, a compliant disclosure notice, notice-and-consent procedures, and staff training, all as one part of a broader compliance and consulting engagement.
Because we are built by clinic operators, we implement the process inside your existing front-desk and scheduling routines, and your practice keeps full ownership of its own billing and patient relationships. If you are weighing whether an outside practice management consultant is worth it, a compliance review is a low-risk place to start. To assess your practice’s No Surprises Act readiness, contact our team at contact@practicemanagementconsultancy.com.
Frequently asked questions about the No Surprises Act
Does the No Surprises Act apply to my private practice?
Yes. The No Surprises Act applies to virtually all licensed providers and facilities that bill patients, including solo and small independent practices. If you treat out-of-network patients, see patients in a facility setting, or serve uninsured and self-pay patients, the law applies to your practice.
Do I have to give a Good Faith Estimate to insured patients?
Not yet. As of 2026, Good Faith Estimates are required only for uninsured and self-pay patients. The related “Advanced Explanation of Benefits” for insured patients remains deferred while federal regulators finish the rules, with a proposal expected during 2026.
What happens if a patient’s bill is higher than the Good Faith Estimate?
If an uninsured or self-pay patient is billed at least $400 more than their Good Faith Estimate, they can start the federal patient-provider dispute resolution process within 120 days of the bill. While the dispute is open, the practice cannot send the bill to collections or charge late fees.
Can a patient waive their No Surprises Act protections?
Only in narrow non-emergency situations, and only with a written notice-and-consent form provided at least 72 hours in advance. Patients can never waive protections for emergency care or for ancillary services such as anesthesiology, radiology, pathology, laboratory, and neonatology.
What are the penalties for a No Surprises Act violation?
Up to $10,000 per violation. A penalty may be waived if the practice did not knowingly violate the law, withdraws the incorrect bill within 30 days, and refunds any overpayment with interest, but a consistent, documented compliance process is the real protection.
Where can I find the official No Surprises Act rules?
The Centers for Medicare & Medicaid Services maintains the federal guidance, model notices, and fact sheets on its No Surprises Act resource center, and publishes a detailed overview of rules and fact sheets for providers.
This article is for general educational purposes and is not legal advice. No Surprises Act requirements can vary with your state’s balance-billing laws and continue to change as federal rulemaking evolves. Consult a qualified healthcare attorney or compliance advisor before finalizing your practice’s policies.
