On July 1, 2021, the Biden administration issued an interim final rule establishing the No Surprises Act (NSA), which introduces consumer protections against high medical costs and has implications for how physical and behavioral health providers bill for services.
The NSA went into effect January 1, 2022. Here’s everything you need to know about how this act will affect behavioral health private practices.
What is the No Surprises Act?
The NSA prevents healthcare consumers from surprise medical billing and removes them from billing disputes between insurance companies and health care providers.
The term “surprise medical bill” refers to unexpected or higher-than-expected charges to the consumer after they receive care from an out-of-network provider. This often happens when consumers are treated at an in-network facility but see an out-of-network provider, or receive emergency care and have no chance to choose their provider.
To protect consumers, the NSA:
- Bans surprise billing following emergency care, non-emergency care from out-of-network providers at in-network facilities (including ancillary care), and out-of-network air ambulance services. In these situations, the ruling mandates that consumers cannot be billed above what the cost would have been from an in-network provider. The rule also affirms that emergency services don’t require prior authorization, regardless of the provider’s network status.
- Requires providers and care facilities to provide good-faith cost estimates up front to patients who are uninsured or self-pay. Providers must make these cost estimates available orally and in writing when consumers schedule a service, or beforehand upon request. Estimates must cover every item or service the patient might be billed for in conjunction with the service they’re scheduling.
- Establishes an arbitration process for billing disputes if consumers are billed more than the good-faith estimate, as long as the difference is at least $400. Consumers will also have expanded avenues to dispute an insurance company’s rejection of a claim.
Who is affected by the No Surprises Act?
The NSA applies to all licensed healthcare providers and facilities, including behavioral health practitioners.
However, it doesn’t apply to all patients. Those with Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, and TRICARE coverage are not included in the new NSA ruling because these programs already have regulations in place to protect against high medical bills. If you exclusively serve clients with coverage from one or more of these programs, the new ruling should not affect you.
How does the NSA affect behavioral health providers?
The ban on surprise medical bills may affect behavioral health practitioners who work in hospitals or other facilities and serve out-of-network patients. This is especially true for those who work in emergency services. However, most behavioral health providers will only be affected by the requirements for good-faith cost estimates.
If you’re a private practitioner working alone or at a group practice, you must still ensure that you and your practice are in compliance with cost estimate requirements. Be prepared to show these estimates to all current and future clients who are uninsured or self-pay. They must be delivered before clients receive the service, and clients can request an estimate before scheduling any service at all.
Good-Faith Cost Estimate Checklist for Behavioral Health
Here are the steps other behavioral health practices are taking to remain compliant with the No Surprises Act:
- Determine whether new patients are insured and if they plan to bill their insurance for your services. If they will not be using insurance, deliver detailed cost estimates, both orally and in writing. The cost estimate should:
- Clearly describe the services you will provide.
- Itemize every component of the service that you will charge for. If a patient has scheduled regular, recurring sessions, clearly state the frequency and duration of sessions scheduled and the cost per session. You do not need to include follow-up services if they will be scheduled separately from the initial service (follow-ups will require their own separate cost estimate at the time of scheduling).
- For every item on the list, include the expected charge as well as the associated procedure code.
- Include a disclosure notice at your practice and on your website clearly stating the availability of cost estimates to uninsured and self-pay patients.
- If fees change, update your clients’ good faith estimates before their next service.
It’s a good idea to have uninsured/self-pay patients sign a document affirming that they have received a good-faith cost estimate. We recommend taking this a step further and providing good-faith cost estimates to all clients, regardless of insurance status, to cover your bases and provide a consistent workflow for your practice.
Behavioral health practices should also consider creating a fee agreement document that clearly lays out your fees and have all patients sign it before treatment begins as part of your intake process. While this is not required as part of NSA, it is a recommended best practice to have a signed fee agreement on file for each patient to aid in the billing process.
Free downloadable and editable templates
We’ve compiled some of the best Good-Faith Cost Estimate and Fee Agreement samples from our Valant community of behavioral health practices and have created these editable templates, available for you to download and customize according to your practices’ needs.
How does Valant’s software support the No Surprises Act?
For practices already using Valant’s Behavioral Health EHR and Practice Management Software, we make it easy to utilize the Patient Portal to upload and access forms, including your Good Faith Estimates and/or a standard Fee Agreement form. Clients can also digitally sign forms using Valant’s eSignature solution.
Alternatively, for practices or patients that choose not to use the Patient Portal, Valant offers the ability to include messaging directly on their patient statements.
Interested in learning more about Valant? Schedule a demo today.
More Information about NSA
More information on the No Surprises Act can be found here:
- https://www.cms.gov/nosurprises
- https://www.apaservices.org/practice/legal/managed/billing-disclosure-requirements
- https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills
- https://www.cms.gov/nosurprises/consumer-protections/Understanding-costs-in-advance
- https://www.dol.gov/newsroom/releases/ebsa/ebsa20210930
- https://www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022/
