No Surprises Act
On Dec. 27, 2020, the No Surprises Act was signed into law as part of the Consolidated Appropriations Act of 2021 (H.R. 133; Division BB – Private Health Insurance and Public Health Provisions). The No Surprises Act is a law that is eliminating or lessening the impact of balance billing on the federal level and most provisions take effect on 1/1/2022. Click here for more information.
WebPT has no obligations under this act.
To bill as an out of network provider, clinics will have to satisfy the following notice and consent requirements:
- Written notice and consent must be received within 72 hours of the item or service being delivered or, if the item or service is scheduled within that timeframe, at the time the appointment is made.
- The notice can be in paper or electronic form (as selected by the patient) and must contain the following information at a minimum:
- Notification that the provider is out-of-network
- A good faith estimate of the charges
- A list of in-network providers at the facility (if the facility is in-network) to which the patient can be referred
- Information on any prior authorization or other care management requirements
- A clear statement that consent is optional and the patient can instead opt for an in-network provider
- The notice must be available in the 15 most common languages spoken in the provider's area.
- The HHS Secretary must issue further guidance on these requirements by July 1, 2021, including specifying the form to document patient consent. However, the legislation requires that this form, at a minimum, includes a space to obtain the patient’s signature agreeing that they were provided with appropriate notice, including a cost estimate, as well as the date on which notice was provided and consent obtained.