In 2020, Congress passed the No Surprise Act (NSA) to protect patients from surprise claims. Some sections of the NSA came into effect on January 1, 2022, while others are pending until the regulation is released. See this post for a general NSA overview.
This new weekly series provides answers to frequently asked questions about the NSA. The first FAQ article answers common questions and focuses on the requirements to notify patients of NSA protection.
Healthcare providers who want to send questions for inclusion in future FAQ articles should send an email to susan.freed@dentons.com.
Scope and effective date
- What kind of healthcare provider and health insurance do I need to comply with the No Surprise Act (NSA)?
The applicability of NSA provisions depends on your requirements, but generally speaking, all licensed healthcare providers must comply with part of the NSA. Health insurance issuers and group health plans, including those sponsored by public and private employers, are also subject to certain NSA provisions that apply to health insurance companies. Medicare, Medicare Advantage, Medicaid, Medicare Managed Care, and other government health insurance are not covered by NSA.
- When will NSA compliance begin?
Some NSA provisions came into effect on January 1, 2022, including disclosure of NSA protections, sincere estimates of out-of-pocket costs, restrictions on certain off-network provider fees, and continued care after changes in the provider network. Improved status and accuracy of provider directories. Other NSA provisions, such as insured patient integrity estimates and advanced profit description (EOB) requirements, will not take effect until a regulation that implements the requirements is issued.
- I have heard that the insured needs to receive a detailed description of the benefits (“EOB”) before receiving the service. When will these requirements begin?
Initially, the advanced EOB requirements were scheduled to come into effect on January 1, 2022. However, regulatory agencies have postponed the compliance date until they release a regulation that implements the new requirements. To date, no regulations have been announced. Therefore, the current compliance deadline is unknown.
Notification to patients regarding NSA protection
- Who Must Provide Patients with NSA Protection Notice??
Hospitals, outpatient surgery centers (“ASC”), critical access hospitals (“CAH”), hospitals and CAH outpatient departments (including provider-based RHC), and individual providers providing services within such facilities. Notify specific patients of NSA protection and publish the notifications on the website and where patients come for service.
- Which patients are eligible for NSA notifications?
Patients with commercial insurance through personal insurance or group health insurance sponsored by a private or public employer must receive a copy of the NSA notice before being billed for service.
Uninsured patients and those who are only eligible for government medical programs such as Medicare, Medicaid, TRICARE, SCHIP, including Medicare Advantage and Managed Managed Care organizations, do not need to be notified.
- What should I include in my NSA notification?
NSA notifications should be a concise, easy-to-understand summary of NSA protection. It will be one page (front and back). The easiest way for a provider to comply is to use the model notifications provided by the CMS.
The Model NSA Notice summarizes applicable state laws related to balance claims and directs drafters to provide contact information with detailed information on patient rights under federal and state law.
For contact information that applies to federal law inquiries that you need to insert, please call https://www.cms.gov/nosurprises/consumers or 1-800-985-3059. You under federal law. For more information on the rights of, please visit https: //www.cms.gov/nosurprises/consumers. “
The provider must work with the state legal adviser where the notice is used to complete the state-specific section. If you are an Iowa provider, you have entered the Iowa-specific information required for draft model notifications.
- Do I need to provide NSA notifications in multiple languages?
yes. Providers and facilities need to make NSA notices (and other notices and consent documents required by other NSA clauses) available in the 15 most common languages in the geographic area where the facility is located. there is. Providers and facilities need to translate model notifications and make them available in the applicable 15 languages. A list of the 15 most common languages in each state is published by HHS.
- When do I need to provide NSA notifications?
NSA notifications must be provided to eligible patients by the date and time the provider requests payment from the patient, including out-of-pocket payments. If the patient does not require payment, the provider must provide notification to the patient’s payer by the date the claim is filed.
For most providers, this means that NSA notifications need to be provided to patients at the time of service. Providers who do not receive payment from the patient at the time of service need to develop a process to ensure that the patient is notified before charging the patient’s payer for the service (such as at admission or discharge). I have.
- How often do I need to provide NSA notifications?
The provisional final rule appears to require a separate NSA notification for each item / service provided to the patient, but currently it seems to be satisfied with the notification being provided once or once a year. Does not look like.
However, some industry associations and other stakeholders are asking regulators to adopt guidance that minimizes the number of times providers must provide this notification to their patients. Until additional guidance is issued to clarify or revise the notification requirements, healthcare providers and providers practicing at healthcare facilities must provide NSA notifications for each service.
- I am an independent doctor providing outpatient surgical services at a local hospital and ASC. Both hospitals and ASCs provide patients with NSA notifications when they check in for services. Also, do I need to provide NSA notifications to patients before or immediately after surgery?
NSA rules allow providers performing services at a healthcare facility to contract with the healthcare facility to provide NSA notifications to avoid duplication. In this case, the independent physician does not need to provide the NSA notification to the patient as long as the healthcare facility agrees to provide the notification to the physician and the NSA notification is actually provided and complies with regulatory requirements.
Physicians and other providers wishing to rely on NSA notifications for healthcare facilities will need to modify their current contract with the facility to include NSA notification clauses or enter into simple contracts related to NSA notice clauses. .. Physicians and other providers servicing healthcare facilities must continue to post NSA notifications on their website.
