No Surprises Act & Good Faith Estimates
January 2024
Over the last few years, provisions focusing on protections and restrictions related to surprise medical bills for patients have been introduced. What do dental and oral surgery providers need to know about these new rules? When does it apply to their patients? How do providers need address and adapt to these evolving changes?
No Surprises Act
The No Surprises Act stands as a critical piece of legislation with implications for healthcare providers in the United States. Beginning on January 1, 2022, this law aims to protect patients from unexpected and often exorbitant charges incurred when they unknowingly receive care from out-of-network providers. Its aim is to not only shield individuals from financial surprise but also foster a fairer marketplace by establishing a dispute resolution process between healthcare providers and insurers.
Good Faith Estimates
A Good Faith Estimate refers to an estimate provided by a healthcare provider to a patient, outlining the anticipated costs associated with medical services or procedures. The aim is to give patients a transparent overview of the potential financial responsibilities they may incur for healthcare services. Key components of a Good Faith Estimate may include:
Procedure or Service Details (including procedure/diagnosis codes)
Estimated Costs (Insurance Coverage, Out-of-Pocket Costs)
Payment Options / Terms and Conditions
Provider/Facility Details (Name, Taxpayer ID, NPI, etc)
The ADA has confirmed that “good faith estimates are now required for uninsured/self-pay consumers” in accordance with the new billing protections for patients under the No Surprises Act – further noting that providers and facilities must provide the estimate 3 business days in advance of services (with the exception of emergency or unexpected situations).
What’s your plan?
Designate a staff member to review resources and assess current practice processes and documentation around patient estimates, specifically for uninsured or self-pay patients. Important steps might include:
Review your estimate process – what information is contained in a patient’s estimate, how and when is it presented, what verbiage is used.
Update documentation and templates to reflect required language and notice of rights.
Set practice policies that ensure patient’s receive necessary estimate information within appropriate timeframe
Dental Billing & Consulting Professionals is also happy to be a resource to you in this process. Our services are customized to each practice’s specific needs and goals. Call or text us at (860) 435-7344 any time for a free consultation on how we can support you in optimizing your billing.
Resource Links
https://www.cms.gov/NoSurprises
https://www.cms.gov/medical-bill-rights/know-your-rights/no-insurance#get-a-good-faith-estimate
https://adanews.ada.org/ada-news/2023/february/ada-receives-clarification-on-no-surprises-act/
https://adanews.ada.org/ada-news/2022/march/ada-addresses-no-surprises-act-questions/