December 13, 2021

CMS Issues Documents to Assist Providers with No Surprises Act Compliance

Holland & Knight Healthcare Blog
Miranda A. Franco
Healthcare Blog

The Centers for Medicare & Medicaid Services (CMS) recently released template documents and model notices to help healthcare providers comply with the No Surprises Act, which was passed as part of the Consolidated Appropriations Act, 2021. Beginning on Jan. 1, 2022, providers no longer can bill patients for more than in-network cost-sharing due under insurance in nearly all scenarios where surprise out-of-network bills arise, except for ground ambulance transport.

The new CMS documents include a template for providing patients a good-faith estimate, model language for informing patients of their rights to a good-faith estimate and patient-provider dispute resolution (PPDR) forms.

To ensure No Surprises Act compliance, providers and facilities must present written and oral cost estimates to patients who are without insurance, covered by a federal healthcare program or not seeking to file an insurance claim. The estimates must be presented on request or at the time of service. CMS also provides templates for documents that the agency and providers send to patients who dispute their medical bills. A detailed description of the required data elements is in the good-faith estimate.

The No Surprises Act also enables uninsured patients to initiate the PPDR process in instances where billed charges exceed the good-faith estimate by $400 or more. A form for starting the process is included in the document release, along with a notice for the U.S. Department of Health and Human Services (HHS) to notify providers the process has been undertaken and a notice used for providers who negotiate a settlement before the selected dispute resolution entity renders a judgment.

CMS also released a memo providing a phone number for patient balance billing complaints and the website where it will post No Surprises Act implementation documents.

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