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CMS Releases New Guidance on Surprise Billing, Good Faith Estimates

Analysis  |  By Jay Asser  
   April 13, 2022

The agency has released further guidance for providers and patients regarding the No Surprises Act.

CMS has published more guidance on the No Surprises Act, including new FAQs surrounding new surprise billing requirements and providing good faith estimates.

Since taking effect on January 1, the No Surprises Act protects patients from unexpected medical charges after scheduled items or services are completed.

This affects the front-end revenue cycle, which must be adjusted to effectively implement requirements for both providers and patients.

To ensure compliance with the No Surprises Act, CMS has continued to release resources outlining answers to common questions. After recently providing updates on good faith estimate requirements, CMS has now published two more sources of material on implementation.

According to the newly published guidance, CMS outlines that providers and healthcare facilities must publicly disclose patient protections against balance billing. Providers must also give a good faith estimate of expected charges to uninsured or self-pay patients at least three business days before a scheduled service (or upon request), according to the new guidance.

Some of the other topics covered in the guidance includes:

  • Additional new surprise billing requirements and prohibitions
  • Provider and facility requirements
  • What types of patients are covered
  • What types of providers the requirements apply to
  • What waiving surprise billing protections entails for patients
  • Administrative and entity fees for the Federal Independent Dispute Resolution process

Meanwhile, highlights from the FAQs on good faith estimates for uninsured and self-pay patients include:

  • When providers are required to provide a diagnosis code
  • If good faith estimates need to be provided after an initial visit
  • How a change in insurance status from the time of scheduling to the time of service affects a good faith estimate

The American Hospital Association (AHA), which previously published a No Surprises Act legislative advisory report and a 15-page summary of the rule, is adding the new information provided by the CMS into its No Surprises Act Implementation Handbook.

Jay Asser is the contributing editor for strategy at HealthLeaders. 

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