Good Faith Estimate and No Surprise Act

[trophyhusband]

It may have already been mentioned, but I've been seeing comments that there's phrasing in the bill implying 2022 will be a bit of a grace period in terms of enforcement, although probably a good idea to just start doing it now (or modifying information you were already giving out).

I've seen mention of delaying enforcement until later in the year. But it's still not clear to me what enforcement means or what penalties for non-compliance would be.

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[AcronymAllergy]

I've seen mention of delaying enforcement until later in the year. But it's still not clear to me what enforcement means or what penalties for non-compliance would be.

Yeah, I don't have a good answer for that, either.

 

[FlowRate]

The APA seems to have pretty reasonable guidelines/recommendations about how to go about doing this. It seems like you can give your cash fee and state that the service may recur. Then just say fee estimate is the cash services for however many times the patient engages in it. It seems like an implementation detail that hasn't been clarified (aint' the law great?) as to whether you have to actually estimate how many times an indefinite service will recur and summarize that cost.

No Surprises Act Implementation

Learn more about the implementation of the “No Surprises Act” (the Act), which allows for patient financial protections that impact health plans, physicians, and facilities, will apply to psychiatrists in certain circumstances.

www.psychiatry.org

 

[Old&InTheWay]

The APA seems to have pretty reasonable guidelines/recommendations about how to go about doing this. It seems like you can give your cash fee and state that the service may recur. Then just say fee estimate is the cash services for however many times the patient engages in it. It seems like an implementation detail that hasn't been clarified (aint' the law great?) as to whether you have to actually estimate how many times an indefinite service will recur and summarize that cost.

No Surprises Act Implementation

Learn more about the implementation of the “No Surprises Act” (the Act), which allows for patient financial protections that impact health plans, physicians, and facilities, will apply to psychiatrists in certain circumstances.

www.psychiatry.org

This site literally states that the law doesn't apply to physician offices. So unless you are a cash based practice working within a hospital or other facility, I don't think you have to do anything.

Edit: or perhaps the "good faith estimate" is a separate part of the law from the emergency care part.

 

[calvnandhobbs68]

This site literally states that the law doesn't apply to physician offices. So unless you are a cash based practice working within a hospital or other facility, I don't think you have to do anything.

Edit: or perhaps the "good faith estimate" is a separate part of the law from the emergency care part.

There's been a lot of argument back and forth about this because this is unclear to a lot of people as well (including billers/malpractice companies)...it seems like many are interpreting the GFE as separate from the emergency provisions part.

Again, totally unclear what the enforcement is going to be like around this and I highly doubt outpatient offices that clearly post their fees ahead of time anyway will be a primary target of any enforcement effort.

 

[FlowRate]

This site literally states that the law doesn't apply to physician offices. So unless you are a cash based practice working within a hospital or other facility, I don't think you have to do anything.

Edit: or perhaps the "good faith estimate" is a separate part of the law from the emergency care part.

The first thing under good faith estimate says it applies to basically all doctors.

What providers and what services are subject to this rule?
“Provider” is defined broadly to include any health care provider who is acting within the scope of the provider’s license or certification under applicable state law. Psychiatrists meet that definition.

The definition of “items and services” for which the good faith estimate must be provided is also broadly defined to encompass “all encounters, procedures, medical tests, … provided or assessed in connection with the provision of health care.” Services related to mental health and substance use disorders (E/M services, psychotherapy, etc.) are specifically included.

 

[TexasPhysician]

The first thing under good faith estimate says it applies to basically all doctors.

It does use generic terms there, but keep in mind that the good faith estimate is only listed is Part 2 of the Act. Part 1 actually lists out the applicable parties.

The attorneys I have spoken to say that it doesn’t make sense to list the applicable parties in Part 1 and then say never mind we meant everyone in Part 2. If that was the purpose, Part 1 should have been rewritten. They believe Part 2 is just clarifying what all physicians and facilities must do at applicable sites to comply with Part1.

It’s terribly done though so I expect lots of revisions.