Overview of No Surprise Act and Good Faith Estimates Billing
The No Surprises Act, which is included in the Consolidated Appropriations Act of 2021, is intended to protect clients from unexpected medical bills. The No Surprises Act's Good Faith Estimates Billing provision is intended to provide clients with an estimate of how much they will be billed for the medical care they will receive prior to their appointment.
How long will it take to provide the Good Faith Estimate?
The Good Faith Estimate must be provided within the following time frame:
- If you scheduled service at least 03 days in advance, the Good Faith Estimate needs to be offered no later than 01 business day after the scheduling date,
- If you scheduled service at least ten days in advance, the Good Faith Estimate needs to be offered no later than 03 business days after the scheduling date,
- In other cases, the Good Faith Estimate must be offered 03 business days after the requested date.
But what about the updated Good Faith Estimate?
Is there any update required?
- If the scope of the original Good Faith Estimate changes, MFTs need to offer an updated Good Faith Estimate. Such updated Good Faith Estimate must be submitted at least 01 business day in advance before the performance of services.
- If Good Faith Estimate has been issued at an individual request, a new Good Faith Estimate at the scheduled service time must be provided by the facility or a provider, irrespective of change in information.
- If either the expected facility or the provider changes at least 01 business day before scheduling the service, the original Good Faith Estimate as it’s own Good Faith Estimate needs to be accepted by the replacement facility or the provider.
What are the steps for creating a Good Faith Estimate?
To create a Good Faith Estimate for a specific client, follow these steps:
- Navigate the Overview page of the client
- Click New > Good Faith Estimate
- Fill out the form by manually updating the range of dates for the estimated number and nature of services
- Add other services by clicking “+Add service”
- Any additional comments can be added using the Notes field
- Click Save
- Review the document
- Click the pen icon for editing
- Click the printer icon for printing
- Click the arrow icon to download
- Click the share icon for sharing with the client for e-signature
Note: You can retract or even edit the document by clicking the X next to the document available under Shared with Client. However, it will be locked once the client signed it.
Do the notice and the Good Faith Estimates have to be provided at each session?
The Interim Final Rules allow a convening provider to provide a single notice and Good Faith Estimate for recurring services and items that are less than a year old. The scope of the recurring services (such as time length, frequency, or recurrences, etc.) must be included in Good Faith Estimate. After 12 months, the provider must provide the client with an updated Good Faith Estimates billing.
Does it apply to current clients in existence before the act’s enactment?
The pre-established and current clients are the same as per the Interim Final Rules. Therefore, the regulations are also applicable to the pre-established current clients.
Are the Good Faith Estimates binding?
Good Faith Estimates are only estimates for the provided services or items, and actual charges may differ from the estimate. However, if a bill is "substantially in excess" of the Good Faith Estimate (at least $400 plus as compared to the total amount of expected charges listed in the Good Faith Estimate), the covered individual may ask for a determination from a designated dispute resolution entity to calculate the paid amount to the facility or the provider for such services or items.
What are the non-compliance penalties?
The Department of Health and Human Services (HHS) recognizes that providers will require time to understand and implement the new requirements. As a result, HHS will use its enforcement discretion with providers from January 1, 2022, to December 31, 2022. "It may take time for providers and facilities to develop systems and processes for providing and receiving the required information from others," HHS acknowledged. Civil monetary penalties of up to $10,000 are applied in enforcement.
What else forms part of the No Surprise Act and Good Faith Estimates Billing?
The No Surprises Act also includes new balance billing restrictions, which typically apply to services provided at in-network facilities by out-of-network healthcare providers. Balance billing (billing consumers for the difference between the out-of-network provider's rate and the insurance payment) for emergency care is prohibited by the Act. Balance billing is only permitted for non-emergency care if the consumer has been given notice and specific consent. There is much more to it, and the best solution is to book an appointment with 24/7 Medical Billing Services to know more about it.
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