No Surprises Act May Be a Surprise
Happy New Year! I hope you had a wonderful holiday celebration and got some time to relax and recharge. Because change is here.
Effective January 1, 2022, the new NO SURPRISE ACT (NSA) is an unwelcome surprise for many therapists!
Very briefly, the primary goal of the NO SURPRISE ACT (Title 45, section 149.610 of the Code of Federal Regulations) is to protect patients and clients from unexpected medical bills. What this means to therapists is that we need to provide a document stating our “Good Faith Estimate” or GFE for treatment. This law was primarily aimed at hospitals’ emergency departments but has been generalized to all providers.
While well-intentioned, the rollout has been confusing. All providers, particularly, private practice therapists are struggling to understand the nuances. There is disagreement among professionals, our professional organizations, and attorneys — and this is OK because the questions we ask will create clarity. As with anything new, it can take time to iron out all the wrinkles. So — take a breath or three.
My team and I are working to understand this new requirement. I’m not going to stress about it because as the law gets implemented, clarification will be forthcoming. Additionally, it appears we have more time to implement this than we thought.
As stated on the CMS website, “HHS understands that it may take time for providers and facilities to develop systems and processes for providing and receiving the required information from others. Therefore, for good faith estimates provided to uninsured (or self-pay) individuals from January 1, 2022, through December 31, 2022, HHS will exercise its enforcement discretion in situations where a good faith estimate provided to an uninsured (or self-pay) individual does not include expected charges from other providers and facilities that are involved in the individual’s care.” The translation is to do your best to comply, and you can expect lenient enforcement for at least the first year.”
From CPH&Assoc
Documentation Wizard will create forms with user-friendly language and content that are 1) more in keeping with being a psychotherapist than a hospital and 2) comply with specific requirements as stated by the law. I will be consulting with attorneys to ensure we’ve complied with the law as we know it. Again, this will take time — and that’s OK.
If you want to take immediate action, here’s what you can do right now to show you’re doing your best to comply:
- Tell your out-of-network clients about the GFE and that a notice will be forthcoming in writing. Then document what you told and how you told them in your progress note. (Did you tell them verbally and give them a written form or just review it verbally?)
- Add the NSA notice to your website.
- You might want to use the CMS forms (link provided below) until I can provide the ones that are more appropriate for psychotherapists.
Model Disclosure Notice Regarding Patient Protections Against Surprise
Billing This is an outline of client/patient rights that seems to be more applicable to hospitals and facilities where emergency services might be provided.
Standard Notice and Consent Documents under the No-Surprises Act
This appears to be the latest version of the Notification of Good Faith Estimate and the Estimate template. It has an expiration date of 3/2022. Remove that expiration date from yours.
In the meantime, here is more information on what to expect going forward in 2022 for the NO SURPRISE ACT.
Stay tuned and we’ll let you know as soon as we have prepared forms ready for you
If you only accept in-network clients, and their insurance is verified before you start counseling, is it necessary to have them complete NSA forms?
You do not need to send the NSA forms to in network clients at this time. That may be a requirement in the future but not yet. At this time, we only need to send the NSA forms to out of network clients and post the info on our website and in our office (for those who still have one).