The No Surprises Act (the Act) was signed into federal law on December 27, 2020, with the intention of protecting patients from unanticipated medical expenses after receiving care from an out-of-network physician, other health professionals, hospital or other providers. Surprise bills arise in emergencies\u2014when patients typically have little or no say in where they receive care. They also occur in non-emergencies when patients at in-network hospitals, ambulatory surgical centers or other facilities receive care from ancillary providers (such as anesthesiologists) who are not in-network.<\/p>\n\n\n\n
The Act applies to all health care providers, which the Centers for Medicare & Medicaid Services (CMS) defines as \u201ca physician or other health care provider who is acting within the scope of practice of that provider\u2019s license or certification under the applicable state law.\u201d In addition to the Act clearly applying to ENT providers, the Academy of Doctors of Audiology and the American Speech-Language-Hearing Association (ASHA) have confirmed that the new regulation\u00a0does indeed apply to audiology and speech-language providers;<\/strong> however, the provisions\u00a0only apply to patients without insurance who are self-paying or insurance where the provider is considered out-of-network.<\/strong><\/p>\n\n\n\n The No Surprises Act supplements state surprise billing laws; it does not supplant them. The Act instead creates a \u201cfloor\u201d for consumer protections against surprise bills. According to The Commonwealth Fund, 18 states offer comprehensive protections against surprise billing, and 15 states offer partial protections. To view an interactive map showing each state, click here<\/a>. If you are unsure of your state laws, contact your state healthcare authority for guidance.<\/strong><\/p>\n\n\n\n While The Act prohibits balance billing for emergency services, balance billing is still allowed for non-emergency care so long as the patient has been given written notice at least 72 hours in advance and they have provided written consent.<\/p>\n\n\n\n CMS has published a Standard Notice and Consent Document<\/a> related to out-of-network care.<\/p>\n\n\n\n The Act requires a new disclosure notice to be publicly available and posted on your practice\u2019s website. Ask your account or regional manager for help branding and printing your signage as well as updating your website; they have access to the approved CMS disclosure content.<\/strong><\/p>\n\n\n\n CMS has published Instructions for Providers and Facilities<\/a> related to the Model Disclosure Notice.<\/p>\n\n\n\n Beginning January 1, 2022, you are required by law to provide a Good Faith Estimate to every new and established patient who is either seeking treatment as a self-pay patient or is considered out-of-network with you as a provider.<\/p>\n\n\n\n Ask your account or regional manager for help branding and printing your Good Faith Estimate form<\/strong> using templates provided by CMS and ASHA.<\/p>\n\n\n\n Beware of Excess Charges<\/strong><\/p>\n\n\n\n Good Faith Estimate must be within $400 of the actual charge(s)<\/strong> to the individual for the service(s) you provided.<\/p>\n\n\n\n The threshold for \u201csubstantially in excess\u201d means that the estimate exceeded the expected charges by at least $400 of what was provided in the Good Faith Estimate.<\/p>\n\n\n\n If this occurs, a patient who is self-paying or not using insurance has the right to challenge the bill through a dispute resolution process<\/strong>. The \u201csubstantially in excess\u201d provision applies to the per-visit cost as opposed to the total plan of care cost. For audiology and hearing aids, consider listing your price per visit for the services and your price per visit for each of the individual\u2019s follow-up visits.<\/p>\n\n\n\nDoes Your State Have a Surprise Billing Law?<\/h2>\n\n\n\n
Balance Billing<\/h2>\n\n\n\n
New Disclosure Requirements<\/h2>\n\n\n\n
Good Faith Estimate<\/strong><\/h2>\n\n\n\n