The No Surprises Act, effective January 1, 2022, is designed to protect patients from unexpected medical bills, particularly when receiving out-of-network care. For mental health professionals, this means providing clear and transparent pricing information before services are rendered. Here’s a breakdown of what the law requires and how to notify your patients.
What Is the No Surprises Act?
The No Surprises Act prohibits surprise medical billing for certain services, particularly when a patient unknowingly receives care from an out-of-network provider. Mental health practices must now provide patients with Good Faith Estimates of expected charges for services, especially for clients who are uninsured or paying out-of-pocket.
What Should Be Included in Patient Notifications?
When notifying your patients under the No Surprises Act, here’s what you need to include:
- Clear Explanation of Services:
Provide a detailed explanation of the services you’ll be offering, including any potential additional services that may arise during treatment. - Good Faith Estimate:
For uninsured or self-pay clients, you must provide a Good Faith Estimate of expected charges. This estimate should cover the full scope of treatment, including therapy sessions, assessments, and any additional fees. Estimates must be accurate and updated if the cost of services changes significantly. - Patient Rights:
Include a statement explaining that patients have the right to request an estimate of expected charges at any time and are protected from being charged more than what is listed on their Good Faith Estimate. If there’s a dispute over charges, patients can engage in a dispute resolution process. - Timeliness of Notification:
Ensure that notifications are provided before the service is rendered. The law requires that you give the Good Faith Estimate at least 72 hours in advance for scheduled services or within one business day for urgent or unscheduled services. - Method of Delivery:
Notifications can be provided either electronically or in writing, but they must be easy for patients to understand. Keep copies for your records to ensure compliance in case of an audit. - Dispute Process:
Inform patients that if the final bill is more than $400 over the Good Faith Estimate, they have the right to dispute the bill via a federal dispute resolution process. Provide them with resources and instructions on how to do so.
Steps for Compliance
To comply with the No Surprises Act, ensure your practice is doing the following:
- Have a system in place to generate Good Faith Estimates for all uninsured and self-pay clients.
- Provide written or electronic notifications to patients with the necessary details.
- Retain copies of all estimates and communications for at least six years to demonstrate compliance.
- Keep your billing and pricing transparent to avoid disputes and potential legal issues.
Sample Good Faith Estimate*
Patient Name: John Smith
Provider Name: Judy Jones, Therapist
Facility: XYZ Health Center
Service Description: Weekly Therapy Sessions
Good Faith Estimate of Expected Charges
Date of Estimate: [Insert Date]
Service: Individual Therapy
Frequency: Weekly Sessions
Cost per Session: $150
Expected Duration of Services: 12 months (52 sessions)
Estimated Total Cost:
Weekly therapy at $150/session for 52 weeks: $7,800
Disclaimer:
This Good Faith Estimate shows the costs of services reasonably expected for your mental health care. The actual charges may vary if additional services are provided. You have the right to dispute the bill if charges are more than $400 over this estimate. For more information about your rights under the No Surprises Act, visit CMS.org.
* Note: This resource is provided as a tool, and as a resource only. Use at your own risk. Clear Path Billing Solutions encourages you to do your own due diligence prior to utilizing this template.
At Clear Path Billing Solutions, we make mental health billing simple and efficient. From timely claims submission to handling denials, we take care of the details so you can focus on your clients. Let us streamline your billing process and improve your cash flow. Book your free consultation today!
