A patient is shocked and angry to receive a bill that is substantially in excess of the patient payment estimation she was given.

Patient Payment Estimation Requirements Under the No Surprises Act

| No Comments

HealthWare Systems Blog

Patient Payment Estimation Requirements Under the No Surprises Act

Posted on Saturday, December 4, 2021

Does your facility have the proper tools to meet the patient payment estimation requirements under the No Surprises Act?

In 2022, the No Surprises Act will require providers or facilities to inquire about patients’ insurance status when scheduling and “provide a good faith estimate of expected charges for items and services” to uninsured/self-pay patients. Uninsured/self-pay patients are those who do not have benefits for an item/service under a health plan or who choose not to have a claim submitted to their plan for the item/service.1

Additionally: “The good faith estimate must include expected charges for the items or services that are reasonably expected to be provided together with the primary item or service, including items or services that may be provided by other providers and facilities.”1

Are You Prepared?

Under the No Surprises Act, if any of your uninsured or self-pay patients is billed for an amount “substantially in excess” (defined as $400 or more) of the good faith estimate you provided to them, they may use a new “patient-provider dispute resolution process” (within 120 days of receipt of the bill) to determine a payment amount.1

The process allows them to request a third-party arbitrator to review the good faith estimate, the bill, and information submitted by you, the provider or facility, to determine whether the excess charges are allowed.2

A patient is shocked and angry to receive a bill that is substantially in excess of the patient payment estimation she was given.

Are you prepared for the No Surprises Act and the new patient payment estimation requirements?

Limit the occurrences of this scenario by implementing the right patient payment estimation solution.

Patient Payment Estimation with Facilitator


HealthWare Systems’ revenue cycle platform, Facilitator, includes a patient payment estimation tool that identifies the potential out-of-pocket costs a patient may incur. And not only can Facilitator help you prepare for the No Surprises Act’s patient payment estimation requirements, but it can also improve your revenue cycle in 2022 by streamlining:

Contact us to learn more about Facilitator, the No Surprises Act and patient payment estimation requirements, and how we can help you reach your revenue cycle goals for 2022!

Sources:

1 CMS (U.S. Centers for Medicare & Medicaid Services). “Requirements Related to Surprise Billing; Part II Interim Final Rule with Comment Period.” (2021). Retrieved from https://www.cms.gov/newsroom/fact-sheets/requirements-related-surprise-billing-part-ii-interim-final-rule-comment-period

2 CMS (U.S. Centers for Medicare & Medicaid Services). “Payment disagreements.” (2021). Retrieved from https://www.cms.gov/nosurprises/consumer-protections/Payment-disagreements


By Stephanie Salmich