|The No Surprises Act 2022 & Good Faith Estimates as of 12-29-2021|
The Good Faith Estimate (GFE) relates to a new law that will go into effect on 1/1/2022. Here is a detailed summary of The No Surprises Act (NSA). I currently have all insurance-based clients so I haven’t been too rushed to hop on this, but I’m sure it’s coming soon for all client types.
-This absolutely applies to therapists in private practice. There seems to be some confusion around what type of provider needs to provide a Good Faith Estimate. At first, it seemed it was only for MD’s and emergency providers.
-Currently, this only applies to our out-of-network clients and our self-pay clients, but if you charge other fees you need to include them in your good faith estimate.
-This is expected to be expanded to in-network clients later in 2022. It looks like insurance providers will soon have to provide these as well. I’m hearing in the Spring.
– Your safest bet is to consult a lawyer to discuss your specific practice and the rules of the NSA and GFE. I called my liability insurance (CPH & Associates) and they “do not offer legal advice related to billing.” They suggested I call a local business attorney to get advice.
I believe it’s best practice to go ahead and implement this in your practice for all clients because you still need to give estimates about no-show fees. I really need to get on that! The expert billers in my Bill Like A Boss membership are already doing this for all of their providers.
Check out these templates to help guide your paperwork. I would recommend creating your own and having a business attorney that specialized in healthcare and mental health law review them.
Template for client disclosure statements.
CMS’s Template for a Good Faith Estimate.
Megan Smith Gunnel of The Thriving Therapist FB group shared her Template for her practice.
A member of my Insurance Billing for Telehealth Practitioners shared this template.
The major EHR’s are starting to add templates to their paperwork. Simple Practice created a form that we can fill out and send to our clients. Here’s a free trial if you aren’t already a member.
Find it in SimplePractice Under Settings, then Notes and Forms, then Assessments, then “Good Faith Estimate for Health Care Items and Services”. Update: Simple practice has just released a new feature that allows e-signatures on all documents. This is going to make implementing the GFE even easier.
I’ve heard therapy notes, therapy appointments, and some other EHR’s have also added these templates for us to use.
Some therapists are just putting the notice on their websites:
“You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
Please contact our office at (xxx)xxx-xxx if you’d like to request a Good Faith Estimate”.
I’ve put together a list of resources to help guide you through this in my Facebook group, Insurance Billing for Telehealth Practitioners here.
Here are a few of the most helpful:
FB group dedicated to this topic
New Billing Disclosure Act
No Surprises Act – Ethics CEU’s available
What MFT’s Need To Know
No Surprises Act: New Billing Disclosures Going Into Effect
What You Need To Know About The No Surprise Act
I hope this helps!!
I will keep you updated, especially when it applies fully to In-Network insurance providers.