- Effective January 1, 2022, the Federal and Massachusetts “No Surprises Acts” require that health care facilities (both hospitals and practices) – at the time of booking notify patients if their insurance plan is considered non-contracted and/or out of network.
- Practices are responsible for following up with a cost estimate of what their balance will be and the patient needs to sign a consent form if they choose to proceed with the appointment.
- As part of this rule, practices are required to publish a notice of the patient’s rights on all entity websites and in office locations.
- If practices do not send an estimate and consent the patient, the practice will get paid a median rate for the visit.
- This amount has not been determined and we don’t know if there is one for visits vs procedures, etc. more to come.
- Estimate Timeline
- Service scheduled 3-9 days in advance Provider has 1 day to deliver the estimate
- Service scheduled 10+ days in advance Provider has 3 days to deliver the estimate
- Interim Process- Practices will need to determine interim method to comply
- Not see these patients
- Accept median rate
- Provide estimate to patient and get the consent signed.
For more information, visit the Centers for Medicare and Medicaid Services.