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Surprise! “No Surprises Act” Enforcement Delayed

by admin on September 8, 2021 No comments

It should come as no surprise that the federal government has decided to delay enforcement of the No Surprises Act.  So although the Act will still take effect on January 1, 2022, the government will not enforce certain provisions of the law until applicable rules are in place.  This will hopefully allow the providers, and the government, time to figure out the best way to comply with the law.

The most difficult provision of the No Surprises Act will likely be the “good faith estimate” requirement.  Under the law, when an individual provider or facility schedules a patient for services, they will be required to gather information about the patient’s payor status.  If the patient has insurance, the provider/facility must send a good faith estimate of the expected charges, billing and diagnostic codes to the insurer.  If the patient is uninsured, that information must be given to the patient.

The government has acknowledged the “complexities of developing the technical infrastructure for transmission of the necessary data” from providers to insurance plans, and therefore agreed to delay enforcement of the good faith estimate requirement, but only as it applies to insurers. However, as it stands now, there will be no delay in enforcing the good faith estimate requirement as it applies to uninsured patients.  Therefore, effective January 1, 2022, uninsured patients will be entitled to the good faith estimate whenever items or services are scheduled for them by a provider or facility.  Enforcement as it pertains to estimates sent to insurance companies will not occur until final rules have been adopted, and as of this writing, no rules have been adopted.

Florida passed its own version of a “No Surprises” law a few years ago, but the federal law adds some additional steps.  We will continue to monitor the rules proposed to apply to the No Surprises Act and will provide updates, in order to avoid any compliance surprises.

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