Signed into law at the end of 2020, the No Surprises Act helps protect individuals (especially the uninsured) from surprise medical bills. The requirements of the No Surprises Act include the need to submit Good Faith Estimates (GFE) to patients when they request items or services while also introducing a resolution process for when a patient’s bill greatly exceeds the GFE provided to them.
What Is the No Surprises Act?
The No Surprises Act helps protect individuals from surprise medical bills by laying out a list of requirements that healthcare providers and facilities must adhere to as of January 1, 2022. One of the key components of the No Surprises Act is the introduction of a Good Faith Estimate (GFE), which must be issued to uninsured individuals and insured individuals with unknown out-of-network coverage.
The Good Faith Estimates (GFE) issued by a provider must be submitted near the time of request or at the time of scheduling. The GFE should include the cost of the primary item or service and any items and services likely to be delivered alongside it over a defined “period of care.” The GFE must also include necessary items and services to be delivered by other facilities.
In addition to requiring Good Faith Estimates, the No Surprises Act also controls how providers and facilities can charge and bill patients, along with restricting activities that could significantly increase a patient’s medical bills under certain circumstances. This includes for insured patients unknowingly seeing out-of-network physicians at in-network facilities.
Requirements of the No Surprises Act
The primary requirements of the No Surprises Act include:
- In almost all circumstances, providers and facilities must give a Good Faith Estimate (GFE) to uninsured individuals.
- In certain circumstances, providers and facilities are not allowed to directly bill individuals for the difference between the amount charged and the amount covered (i.e., balance billing).
- For certain providers and facilities, restrictions on balance billing must be publicly disclosed.
- When a provider’s network status changes mid-treatment, or a patient acts on inaccurate directory information, the billed amount is limited to protect patients from circumstances beyond their control.
- If a patient’s bill exceeds the good faith estimate provided to them, the No Surprises Act lays out a dispute resolution process to help them contest additional charges.
Almost all providers and facilities must adhere to the No Surprises Act, including physicians, hospitals, and air ambulance services.
How TempDev Can Help You Be Compliant with the No Surprises Act
TempDev’s team of experienced consultants, developers, and trainers are here to support enhanced accessibility, as well as customized features and templates. This enables you and your patients to have more control over data with improved transparency. Since the key to being compliant with the No Surprises Act is being transparent, it is important that you have a process in place for supplying GFEs to uninsured patients and understanding each physician’s network coverage.
As part of our streamlining process, we help you implement the Patient Portal, API, and other tools to better support safety, patient engagement, and security. From dashboards to automation and workflow redesign, TempDev offers the comprehensive resources and tools you need to ensure proper compliance with the No Surprises Act.
Contact us here or by calling us at 888.TEMP.DEV to optimize your compliance with the No Surprises Act.