These are largely intended for scheduled in-patient procedures but can be applied to planned outpatient services as well. The law has specific guidelines for when a patient must receive a Good Faith Estimate. Timing Requirements and Delivery Format for Providing a Good Faith Estimate CMS has a sample that you may use for reference.Ĭurrently, patients who have Medicare, Medicaid, or any other federal health care program, are exempt from this process. Patients who do not have insurance or who are not using their health insurance to cover visits are required to receive a notice of their right to request a Good Faith Estimate at any time.
See ASHA’s webpage on Good Faith Estimate Templates for Audiologists and Speech-Language Pathologists. To comply with the new law, y ou must have the patient sign the Good Faith Estimate form and maintain the signed document in the patient’s medical record. Many providers develop a Good Faith Estimate form for self-paying patients and those where you, as a provider, are considered out-of-network. Complying with No Surprises Act Requirements Good Faith Estimate Forms
Share the expected range of follow-up visits and consider adding a total expected cost range. Best practices for your Good Faith Estimate would be to list your price per visit for the evaluation and your price per visit for each of the individual’s follow-up visits. The “substantially in excess” provision applies to the per visit cost as opposed to the total plan of care cost. If this occurs, a patient who is self-paying or not using insurance has the right to challenge the bill through a dispute resolution process. The threshold for “substantially in excess” means that the estimate exceeded the expected charges by at least $400 of what was provided in the Good Faith Estimate. To protect patients, the law also requires that the provider’s Good Faith Estimate must be within $400 of the actual charge(s) to the individual for the service(s) you provided. A Good Faith Estimate is the best judgment of the cost of care a provider plans to offer to the patient across the episode of care. Beginning January 1, 2022, audiologists and speech-language pathologists (SLP) are required by law to provide a Good Faith Estimate to every new and established patient who is either seeking treatment as a self-pay patient or is considered out-of-network with you as a provider. This is the portion of the regulation that will impact audiology and speech-language pathology the most. The regulation includes a provision for Good Faith Estimates, which informs patients of the cost of care they will be receiving before their appointment. No Surprises Act Impact on Audiologists and Speech-Language Pathologists However, the provision only applies to patients without insurance who are self-paying or insurance where the provider is considered out-of-network. The regulation applies to all health care providers, which the Centers for Medicare & Medicaid Services (CMS) defines as “a physician or other health care provider who is acting within the scope of practice of that provider’s license or certification under the applicable state law.” This means that the new regulation applies to both audiology and speech-language pathology providers. Understanding the Intent of the No Surprises ActĬongress enacted the No Surprises Act (the Act) to protect patients from costly, unexpected medical bills. ASHA provided comments on the No Surprises Act before the regulation was finalized. The federal regulation called the No Surprises Act (P.L.
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