Wiki No Surprises Act

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Nramos03

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I'm unclear on this - maybe just need to do more intense reading - but if anyone can simplify this for me, I'd appreciate it.
Just seems like there's a lot of what the provider's can't do and very little of what the payer's responsibility is. I'm so confused. Does anyone know of a hotline I can reach out to to have this explained to me?
 
Don't forget that right now, for an insured patient, you only need to provide the estimate if a patient asks for it. You are required to provide it (even without patient asking) for self pay patients our out of network patients being seen at an in network facility.
I think I recall seeing good guidance on the AMA website. I would recommend starting there.
 
Hi
Surprise Billing I believe entails if a Medicare funded patient (not commercial payer) should sign a ABN form when treatment will not covered. You cannot bill this patient later. The Medicare patient must sign a ABN form first and given a copy and one saved before service is rendered to ensure they know Medicare will not cover the treatment. Of course true emergency life or death status patients cannot do this ABN form .
Also with Surprise Billing (or sometimes Balance Billing ).....you cannot take a patient's insurance, never bill the treatment and send balance to the patient. Or if insurance billed then balance left over owed by patient must bill this to the patient's home address in a timely manner or to 2nd payer if coordinated.. You cannot wait over a year then bill the patient for balance not paid or processed. All points to processing claims in timely manner and do preauthorizing if part of insurance payer contract requires it.

I hope this data helps you
:)
Lady T
 
Nramos03 said:
I'm unclear on this - maybe just need to do more intense reading - but if anyone can simplify this for me, I'd appreciate it.
Just seems like there's a lot of what the provider's can't do and very little of what the payer's responsibility is. I'm so confused. Does anyone know of a hotline I can reach out to to have this explained to me?
Click to expand...
I don't know of a free hotline but if you look around online you may find health care law firms that are hosting free webinars on the rule. CMS has a number of fact sheets here https://www.cms.gov/nosurprises/policies-and-resources/provider-requirements-and-resources.
 
This act is driving me nuts as well. I have reviewed all of the CMS information and still feeling out of sorts. I am in a dental college and while I understand that dental group plans are excluded/exempted, I have an ASC and providers that bill medical which may place me back in the process. My providers are screaming that this Act doesn't apply to dental and the educational environment because it references "dental office" when in fact, the guidance states that no specialty is excluded and that the uninsured/underinsured good faith estimate is for all patients that fall in this category. In the dental world, we are expected to provide estimates as dictated by the guidance from the American Dental Association however, the issue is posting the notices and communicating the NSA in the manner indicated in the guidance AND ensuring that the estimates are complete and accurate when provided (meeting the definition of good faith in my opinion). If anyone can provide any insight on dental and the NSA, please do so.
 
The information I have been reading looks like it only applies to Hospitals, hospital outpatient departments, critical access hospitals, and ambulatory surgical centers. I work in chiropractic offices and I am just not seeing that this applies to us. Or dental, OR anyone outside the places I mentioned earlier. Am I missing something? we don't balance bill anyways and communicate as much as possible what the patient will owe- but we don't do Good Faith Estimates officially so that is what we are concerned about.
 
oknightsims said:
This act is driving me nuts as well. I have reviewed all of the CMS information and still feeling out of sorts. I am in a dental college and while I understand that dental group plans are excluded/exempted, I have an ASC and providers that bill medical which may place me back in the process. My providers are screaming that this Act doesn't apply to dental and the educational environment because it references "dental office" when in fact, the guidance states that no specialty is excluded and that the uninsured/underinsured good faith estimate is for all patients that fall in this category. In the dental world, we are expected to provide estimates as dictated by the guidance from the American Dental Association however, the issue is posting the notices and communicating the NSA in the manner indicated in the guidance AND ensuring that the estimates are complete and accurate when provided (meeting the definition of good faith in my opinion). If anyone can provide any insight on dental and the NSA, please do so.
Click to expand...
mbodily5 said:
The information I have been reading looks like it only applies to Hospitals, hospital outpatient departments, critical access hospitals, and ambulatory surgical centers. I work in chiropractic offices and I am just not seeing that this applies to us. Or dental, OR anyone outside the places I mentioned earlier. Am I missing something? we don't balance bill anyways and communicate as much as possible what the patient will owe- but we don't do Good Faith Estimates officially so that is what we are concerned about.
Click to expand...
Per this healthcare attorney, the No Surprises Act applies to all licensed healthcare professionals. Dentists and chiropractors included.
mccartylaw.com

No Surprises Act a Big Surprise to Many Health Care Providers

mccartylaw.com mccartylaw.com
 
mbodily5 said:
The information I have been reading looks like it only applies to Hospitals, hospital outpatient departments, critical access hospitals, and ambulatory surgical centers. I work in chiropractic offices and I am just not seeing that this applies to us. Or dental, OR anyone outside the places I mentioned earlier. Am I missing something? we don't balance bill anyways and communicate as much as possible what the patient will owe- but we don't do Good Faith Estimates officially so that is what we are concerned about.
Click to expand...

mbodily5 said:
The information I have been reading looks like it only applies to Hospitals, hospital outpatient departments, critical access hospitals, and ambulatory surgical centers. I work in chiropractic offices and I am just not seeing that this applies to us. Or dental, OR anyone outside the places I mentioned earlier. Am I missing something? we don't balance bill anyways and communicate as much as possible what the patient will owe- but we don't do Good Faith Estimates officially so that is what we are concerned about.
Click to expand...
I went to a webinar last week by CMS and they were very specific in stating that there are no specialties or type of providers exempt from this Act however they did clarify that the Good Faith Estimates for uninsured/underinsured patients is necessary if the services provided will be billed to a group health plan or if the patient requests the information. That answered my question as to whether or not dental was included.
 
oknightsims said:
I went to a webinar last week by CMS and they were very specific in stating that there are no specialties or type of providers exempt from this Act however they did clarify that the Good Faith Estimates for uninsured/underinsured patients is necessary if the services provided will be billed to a group health plan or if the patient requests the information. That answered my question as to whether or not dental was included.
Click to expand...
Oh good info. So if they are uninsured/underinsured and not billing to a group health plan and don't request a GFE, we do not have to do one? For our new patients, we already lay out the cost of treatment for time of service (not using insurance)- so if they are not requesting a GFE wondering if we still Have to do one.
 
I really appreciate all of this information.

We are a lab - so we do not see the patients at all. We cannot count on our clients that send to us to get our information to them, although provided. So this is what worries me about compliance. Does anyone know anything on this scenario or is in the same boat as I am? How are you handling? Is providing to our clients enough to be in compliance?
 
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