CMS Releases FAQs for No Surprises Act Implementation

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The Centers for Medicare and Medicaid Services (CMS) has released new Frequently Asked Questions (FAQs) on the No Surprises Act’s implementation, which include information on balance billing and notice and consent restrictions.

The No Surprises Act forbids charging patients more than their applicable cost-sharing amounts by nonparticipating
physicians and emergency institutions, also known as balance billing.

Depending on the services they offer and the environments in which they practice, different providers have different
restrictions on balance billing and cost-sharing safeguards.

For example, if they provide emergency services for a medical condition related to a visit to a hospital’s emergency department or an independent free-standing emergency department, nonparticipating providers and nonparticipating emergency facilities are prohibited from balance billing and must abide by cost-sharing restrictions.

Nonparticipating providers who offer nonemergency services must abide by the rules when the services are rendered in conjunction with a patient’s visit to an in-network hospital, hospital outpatient department or ambulatory surgical facility.

Additionally, providers or facilities that provide care to people with public health insurance coverage—including Medicare, Medicare Advantage, Medicaid, Medicaid managed care plans, Veterans Affairs Health Care, the Indian Health Service and TRICARE—are not covered by the balance billing protections under the No Surprises Act, according to CMS.

The No Surprises Act’s notice and consent procedures were also included in the FAQs. If they give notice and get the person’s permission to forego the protections, providers and facilities may hold patients liable for more than the applicable cost-sharing amount for a service.

According to CMS, a facility operating on behalf of a nonparticipating provider or the provider itself may notify and solicit consent from a person. The written notice and consent must be kept by the facility for at least seven years if it
receives the consent. The notification and consent must be kept for seven years if a provider accepts the consent; otherwise, the provider must work with the facility to arrange for the facility to keep them
for that long.

Finally, the FAQs noted that facilities or providers cannot ask a patient’s permission to forego No Surprises Act protections at the moment care is to be provided. The notice and permission document must be given to the person at least 72 hours before the services if they are scheduled at least 72 hours in advance.

Read the full list of FAQs here.

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