Since the No Surprise Act (NSA) became effective on January 1, 2022, medical offices are experiencing trouble understanding and implanting the new requirements to remain compliant with the NSA guidelines. On January 20, 2022, the Medical Group Management Association (MGMA) called on the Centers for Medicare and Medicaid Services (CMS) and the US Department of Health and Human Services (HHS) to delay the enforcement of the NSA guidelines until practices have the time to understand the rules and execute new workflows.
Under the NSA guidelines, providers are required to provide “Good Faith Estimates” to patients who are uninsured or do not want to submit a claim to their insurance company. Providers and facilities are required to inform patients who choose to continue care, both orally and in writing, a cost estimate of the care needed or required. With the ongoing COVID-19 pandemic creating staffing issues, the MGMA argues that implementation of these requirements should be delayed. Many medical offices are having trouble getting these estimates to the patients within the allotted amount of time, which is currently upon the request or at the time of scheduling.
CMS created and released templates for these “Good Faith Estimates,” which can be found on CMS.gov or by clicking here for the Good Faith Estimate or here for the Consent Documents.
Some of the required data elements include patient demographics, diagnosis, provider information and facility charges. A signature on either form provides consent for the following:
– Patient or subscriber may be giving up some consumer billing protections under federal law
– Patient or subscriber may be billed for the full charges for services or have to pay out-of-network costs under the health plan
– Patient or subscriber fully and completely understand that some or all amounts paid might not count towards their health plan’s deductible or out-of-pocket limit
Patient/Subscriber signatures are not required on either document however, if the patient chooses not to sign, the provider can opt out of providing care.
References & Resources:
https://revcycleintelligence.com/news/cms-provides-guidance-on-good-faith-estimates-for-no-surprises-act
https://support.simplepractice.com/hc/en-us/articles/4418210427021-The-No-Surprises-Act-and-Good-Faith-Estimates#forms
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Physicians Group Management (PGM) is one of the fastest-growing medical billing companies in the United States. For over 35 years, PGM has been providing medical billing and practice management services and software to physicians, healthcare facilities, and laboratories. PGM’s current client base encompasses the full spectrum of medical specialties, including Internal Medicine, Dermatology, Plastic & Reconstructive Surgery, Pathology, EMS & Ambulatory Services, Cardiology, Nephrology, Urology, Pain Management, OB/GYN, Gastroenterology, Independent Laboratory, and many more. PGM’s medical billing and practice management solutions include: –
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