The No Surprises Act (NSA) went into effect on January 1, 2022. This law is designed to protect patients from surprise medical bills, also known as balance bills, in emergency and non-emergency situations and creates a mechanism for physicians and payors to address the bills for medical services. This Act ensures that patients are only responsible for in-network cost-sharing, requires that patients be provided certain information including up-to-date directories, and creates an independent dispute resolution process to ensure physicians and health insurers can resolve billing disputes. There is information that medical practices should post publically on their website to comply with this new law. Let’s take a deeper dive.
Under the No Surprises Act, there are instances in which patients can knowingly and voluntarily waive their balance billing protections and consent to be billed for out-of-network services. Notice and consent requirements are met if:
- The patient is provided written notice and consent 72 hours in advance of their appointment.
- Documents provided to patients must include a good faith estimate of the costs of the services to be provided.
- A list of in-network providers at the facility and information regarding medical care management, such as prior authorization are provided.
Provide notice and consent documents for balance billing of non-emergency services
Each provider is required to make publicly available, including on its website and to each patient who is enrolled in a commercial health plan, a disclosure regarding the patient protections against balance billing. Non-participating providers at participating facilities may not bill a patient more than the cost-sharing requirements or balance bill the patient unless the notice and consent requirements are met. Access to these documents should be publically available within one click from the provider website home page.
HHS has created a model notice that providers should use. The patient must sign and date the receipt of the notice and sign and date the form consenting to out-of-network services.
You can use the Model Notice from HHS as long as you edit it to meet your specific use case.
Consider language
The regulations require that providers provide the notice and consent in the top 15 languages spoken of the state or geographic region in which the provider is located.
Provide a good faith cost estimate
The statute also requires that a good faith estimate of the costs of services be provided to inform patients of their potential out-of-pocket costs if they continue with care from out-of-network providers. The good faith estimate should include the expected billing and diagnostic codes for items and services.
List what health plans you are considered in-network for
While not a requirement of providers to post on their website, it is suggested that providers list what health plans they are in-network for. Since some plans may exclude coverage for certain services such as outpatient surgery, laboratory and diagnostic services, and specialty drug therapies, it is recommended to add a disclaimer to your site that advises patients to contact their health plan directly to confirm.
Sources
https://www.cms.gov/nosurprises
https://www.ama-assn.org/system/files/2020-12/no-surprises-act-summary.pdf
https://www.ama-assn.org/system/files/ama-nsa-toolkit.pdf
