Your Practice & the “No Surprises” Act

According to an email I received yesterday:

“In a nutshell, The “No Surprises Act” requires that patients are notified of specific costs prior to receiving the services. This includes cash based practices.”

The email goes on to specify that you must give each & every patient a good faith estimate of costs prior to care. This seems to be generating some confusion. First, let’s review which patients are specifically targeted by this legislation:

• The related CMS content can be found here: https://www.cms.gov/nosurprises.
• This legislation targets patients “who get emergency care, non-emergency care from out-of-network providers at in-network facilities” (Hospitalized patients are the most likely recipients here!)
• Furthermore: “Providers, facilities and air ambulance providers are also required to give uninsured (or self-pay) individuals good-faith estimates of expected charges for scheduled health care services.“
• An overview with links can be found here: https://www.cms.gov/nosurprises/policies-and-resources/overview-of-rules-fact-sheets
• Guidance regarding good faith estimates and the Patient-Provider Dispute Resolution can be found here: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Guidance-Good-Faith-Estimate-Patient-Provider-Dispute-Resolution-Process-for-Providers-Facilities-CMS-9908-IFC.pdf

Now let’s discuss it. For most providers who generally see non-emergency patients during scheduled visits at their offices, this should simply be “business as usual.” The legislation takes aim at unexpected emergency care/bills relating to situations like:

• An out-of-network physician treating an insured patient at an in-network hospital. (There aren’t many alternate situations where this would happen in a doctor’s office.)
• Air ambulances — which can cost $40,000!!!

The overwhelming goal is to protect consumers from catastrophic costs for unexpected bills.

Your patients should be always be apprised of costs at the beginning of care. Most providers I know already operate this way. And it’s important that you don’t bury any disclosed fees under a mountain of other patient forms. (Yes… that’s specifically noted in the CMS documentation.)