Breaking News

No Surprises Act (update)

As promised, we are working to keep you in the loop on the No Surprises Act.  We’ve attended a few webinars and read what CMS has provided to date.  The end result?  CMS seems to have not yet finalized the details of this Act, which leaves the available information rather confusing and disorganized at this point.  (see CMS details here)

What we do know.  You will need to eventually do the following.  CMS states as of January 1, 2022, however the expected process is still unclear.  Our recommendation is to implement following January 1st:

Provide a Good Faith Estimate to:  (Required as of 1/1/2022)

  • Uninsured patients
  • Patients who are insured but elect not to use their coverage
  • Patients who are insured but do not have coverage for a certain item or service
  • Out-of-Network patients who choose to use their insurance

Prepare for additional information once there is more clarification from CMS on this topic.  In the meantime, you can start to implement the following procedures in your office that will serve to help you once we do have more information:

  • Know which insurance companies you are In-Network with and which you are Out-of-Network with
  • Keep a clear list of those companies available at the front desk, easily available to reference for all team members.                                                                                  
  • Verify benefits

Start a notification process during New Patient Scheduling for a verbal good faith estimate (in addition to your written version):

  • This is still a grey area.  Once we have additional clarification and requirements on this process we will update you.
  • You need to determine if a patient has insurance they intend to use at your clinic AND you are required to inform them of your network status with their insurance.
    • Most of you are already doing this step:  “Thank you Mrs. Jones for calling our clinic.  Do you have insurance you would like to use toward your care?  We are in/out-of-network for your insurance.  Please be sure to bring your card to your appointment… and so on.”

Again, many of the details of the No Surprise Act are still unclear.  As we know more, we will continue to share more.

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