Compliance Uncategorized

Don’t Be Surprised By the No Surprises Act Notice and Good Faith Estimate Requirements

April 11, 2022

Even though a federal court struck the U.S. Department of Health & Human Services’ No Surprises Act (“NSA”) regulations as pertain to the process for arbitrating disputes between payors and out-of-network providers, the law and the remaining implementing regulations remain in effect.

Although much of the attention has been placed, for good reason, on the operative billing-related restrictions imposed by the NSA, the technical notice requirements require immediate attention.

In particular, the regulations require that patients be given a notice of rights and, should they so request, a good faith estimate of charges.

For facility-based groups, the hospital or facility will almost always (but not completely) be charged with providing notice to patients and responding to requests from uninsured and self-pay patients for good faith estimates of charges. But the obligation to provide the notice and estimate does not obviate the need for all medical practices to provide required website notice, nor does it, unless you want to give up financial control, obviate the need to coordinate how the charges for your services will be estimated by the hospital or ASC. 

Despite the fact that much of this can be offloaded to the facility, it’s wise for all facility-based providers (and required of all office-based providers) to include notice on the practice’s website. Although HHS has provided a form of notice, the use of which demonstrates a good faith effort to comply, it must be customized to incorporate applicable state law. Print copy notices must be made available and (in nearly all cases) posted.

Although the law has been in effect as of January 2022, the government is exercising discretion as to enforcement of the good faith estimate requirement. The better approach, though, is to address these issues ASAP.



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