In 2022, the No Surprises Act will require providers or facilities to inquire about patients’ insurance status when scheduling and “provide a good faith estimate of expected charges for items and services” to uninsured/self-pay patients. Uninsured/self-pay patients are those who do not have benefits for an item/service under a health plan or who choose not to have a claim submitted to their plan for the item/service.1
Additionally: “The good faith estimate must include expected charges for the items or services that are reasonably expected to be provided together with the primary item or service, including items or services that may be provided by other providers and facilities.”1
Under the No Surprises Act, if any of your uninsured or self-pay patients is billed for an amount “substantially in excess” (defined as $400 or more) of the good faith estimate you provided to them, they may use a new “patient-provider dispute resolution process” (within 120 days of receipt of the bill) to determine a payment amount.1
The process allows them to request a third-party arbitrator to review the good faith estimate, the bill, and information submitted by you, the provider or the facility, to determine whether the excess charges are allowed.2
Limit the occurrences of this scenario by implementing the right patient payment estimation solution.
HealthWare Systems’ revenue cycle platform, Facilitator, includes a patient payment estimation tool that identifies the potential out-of-pocket costs a patient may incur. Not only can Facilitator help you prepare for the No Surprises Act’s patient payment estimation requirements, but it can also improve your revenue cycle by streamlining:
Pre-arrival workflow
Insurance verification
Medical necessity checking
Financial assistance screening
Appeals management
Release of information
Contact us to learn more about Facilitator, the No Surprises Act, and patient payment estimation requirements, and how we can help you reach your revenue cycle goals for 2022!
DISCLAIMER: This blog is intended for informational purposes and should not be interpreted as legal advice.
Sources:
1 CMS (U.S. Centers for Medicare & Medicaid Services). “Requirements Related to Surprise Billing; Part II Interim Final Rule with Comment Period.” (2021). Retrieved from https://www.cms.gov/newsroom/fact-sheets/requirements-related-surprise-billing-part-ii-interim-final-rule-comment-period
2 CMS (U.S. Centers for Medicare & Medicaid Services). “Payment disagreements.” (2021). Retrieved from https://www.cms.gov/nosurprises/consumer-protections/Payment-disagreements