It’s been more than six months since the No Surprises Act (NSA) took effect, so we thought it would be helpful to revisit this importance piece of legislation and review compliance expectations for ambulatory surgery centers (ASCs).
As a refresher, Congress passed the NSA in 2020 and it became effective January 2022. The law’s aim is to protect patients from receiving a bill when they have received services from an out-of-network (OON) provider through no fault of their own. The law increases pricing transparency for patients who received services from OON providers. It also covers patients in states that do not have surprise billing (also known as balance billing) laws or those whose laws are not comprehensive.
For this article’s purpose, we’ll divide the law’s requirements into three buckets: disclosures/notices, consent and good faith estimates, and dispute resolution.
Disclosures/Notices/Consents
The NSA requires ASCs to post notices to patients about surprise billing protections; consent for OON services; and good faith estimates outlining the patient’s financial responsibility. These must be displayed in the facility, posted on the facility’s website, and provided to the patient.
The notice must be posted in the facility in a similar manner as the HIPAA privacy notice. One recommendation is ASCs display this notice in the same place as the HIPAA and patient’s rights and responsibilities notices. On the facility’s website, the notice must be either on the website’s home page or a link to the disclosure/notice must be on the home page. When the document is provided to patients, they must be given a choice to receive the written notice and consent document in any of the 15 most common languages in the state where the ASC is located. They also have the choice to receive the information electronically or via hardcopy.
Good Faith Estimates
ASCs are required to provide patients with a good faith estimate. At this time (summer 2022), these estimates are required for self-pay patients. Self-pay patients are defined as follows:
- Those who have no insurance.
- Those who have insurance but choose not to use it.
- Those who have no coverage for OON services.
Good faith estimates not only cover the facility but also services provided by other providers (e.g., anesthesiology, pathology). The surgeon’s office may choose to provide their own good faith estimate, or they may choose to provide the ASC the data for its inclusion with the estimate the ASC provides. We expect additional requirements in 2023. However, regulatory bodies have not stated if these changes will increase administrative work for the ASC or surgeon’s office.
When should you provide patients with good faith estimates?
- When a service is scheduled within three business days, a good faith estimate must be provided within one business day of scheduling the service.
- When a service is scheduled within 10 business days, a good faith estimate must be provided within three business days of scheduling the service.
- When an estimate has been requested, it must be provided within three business days.
Dispute Resolution
Independent dispute resolution (IDR) is a very important component of this law. Patients can dispute their bill when it is at least $400 more than the good faith estimate. As noted, ASCs will often provide good faith estimates for its services and for services provided by other providers.However, the ASC is only responsible for the accuracy of the center’s estimate. If a patient wants to dispute one of the other providers’ good faith estimates, the patient will need to contact that provider.
Compliance
Surprise billing laws are patchwork. There is the federal NSA, but there are also state regulations concerning surprise billing. You must be aware of and comply with both. State regulations can override the federal ones if they are offer patients more protections. CMS has released multiple files, forms and notices to help ASCs comply with the federal regulation.
No Surprises Act: What’s Next?
In 2022, most ASCs will find the good faith estimate and dispute resolution portion of this law affects a small percentage of their patient population. However, in the coming year, there is an expectation that the NSA rules will expand and add more administrative procedures. It is wise to ensure your ASC’s policies, procedures and supporting documents are in order and implemented properly to ensure compliance with federal and state surprise billing rules.