As indicated in this article from January 19, the No Surprises Act—legislation designed to protect consumers against surprise medical billing in private insurance for most emergency and some instances of non-emergency care—was signed into law as part of the Consolidated Appropriations Act of 2021. This act also includes requirements that uninsured and self-pay patients receive key information, including overviews of anticipated costs and details about their rights.
Good Faith Estimate Requirement for Uninsured or Self-Pay Patients
The Academy and other interested stakeholders have received confirmation from regulators that all provider types are required to provide all self-pay, uninsured or out-of-network patients with a “good faith estimate” of the cost of care. A “good faith estimate” is defined as the best judgement of the cost of care a provider plans to provide across the episode of care. The estimate must be provided in writing, signed by the patient and included in the patient’s medical file.
If the actual patient charges are more than $400 over the “good faith estimate,” the patient has the right to challenge the bill through a dispute resolution process.
- CMS “Good Faith Estimate” Template
- CMS webpage devoted to “No Surprises Act”—including bill text and FAQs.
Academy Working with Stakeholders for Enforcement Delay and Exemption for Small Practices
The Academy, along with other stakeholders, is requesting a complete enforcement delay as well as expanded enforcement discretion for all aspects of the good faith estimate. In addition, the coalition is requesting an exemption for small practices—with 15 or fewer clinicians (see attached letter).
This legislation was implemented in a hurried fashion under an interim final rule—with limited ability for stakeholder comment. The Academy will continue to provide member updates on this topic as they become available.
A growing body of evidence demonstrates the connection between health outcomes to income, education, nutrition, housing, environmental exposures, and other social circumstances. Similarly, studies have shown that interventions addressing SDOH can improve health outcomes and reduce health care costs. In response, the Biden-Harris Administration has released a playbook outlining new or strengthened initiatives that agencies…
The U.S. Department of Health and Human Services Office of Inspector General (OIG) posted on October 25, 2023 Advisory Opinion No. 23-08, in which OIG rejected a proposed arrangement from a cochlear implant device manufacturer (the requestor) that would provide a free hearing aid to certain qualified patients who received a cochlear implant. OIG concluded the…
Representatives Bilirakis and Cartwright Introduce the Medicare Audiology Access Improvement Act of 2023 (H.R. 6445)
On November 17, 2023, Representative Gus Bilirakis (R-FL) and Matt Cartwright (D-PA) introduced the Medicare Audiology Access improvement Act (H.R. 6445). This legislation is also co-sponsored by Representatives Johnson (R-OH), Shakowsky (D-IL), Mace (R-SC), Blunt Rochester (D-DE), Fitzpatrick (R-PA), Trone (D-MD), Webster (R-FL), Cohen (D-TN), LaMalfa (R-CA), Grijalva (D-AZ), Foster (D-IL) and Pocan (D-WI). Senators Elizabeth…