The No Surprise Act Final Rule took effect September 30, 2021.
According to CMS.gov: “On September 30, 2021, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (collectively, the Departments), along with the Office of Personnel Management (OPM), released an interim final rule with comment period, entitled “Requirements Related to Surprise Billing; Part II.” This rule is related to Title I (the No Surprises Act) of Division BB of the Consolidated Appropriations Act, 2021, and establishes new protections from surprise billing and excessive cost sharing for consumers receiving health care items/services. It implements additional protections against surprise medical bills under the No Surprises Act, including provisions related to the independent dispute resolution process, good faith estimates for uninsured (or self-pay) individuals, the patient-provider dispute resolution process, and expanded rights to external review.”
How will the No Surprise Act Final Rule affect your anesthesia practice? Below are a few takeaways on how your anesthesia practice may be affected.
- Before initiating the new Independent Dispute Resolution (IDR) process, parties must first enter into a 30 day negotiation period to determine a payment rate. If the parties fail to reach an agreement following the negotiation period, either party may initiate the IDR. The parties must select a CMS approved Certified Independent Dispute Resolution Entity. In the No Surprise Act, effective 2022 each party is required to pay an administrative $50 fee to initiate the process.
- For independent anesthesia practices it is unclear where anesthesia fits in the Good Faith Estimates for Uninsured. In the No Surprise Act Final Rule, the CMS Fact Sheet states: “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. For example, for a surgery, the good faith estimate might include the cost of the surgery, any labs or tests, and the anesthesia that might be used during the operation. If an item or service is something that isn’t scheduled separately from the surgery itself, it will generally be included in the good faith estimate.” We recommend providing your facility with an estimate of your anesthesia and related services such as blocks, ultrasound guidance, arterial lines, etc. for uninsured patients.
- The No Surprise Act Final Rule says there will be a Dispute Resolution Process for uninsured patients that receive a bill “substantially in excess” of the good faith estimate. HHS has defined “substantially in excess” as the billed charges being at least $400 more than the good faith estimate. The Fact Sheet further indicates: “Select Dispute Resolution” entities will make payment determinations as part of the patient-provider dispute resolution process. The patient-provider dispute resolution process has timelines for documentation submission, payment determination, and participating individuals will be charged an administrative fee. To ensure the administrative fee does not act as a barrier for consumers accessing dispute resolution, the fee will be set at $25 in the first year and will be updated through sub-regulatory guidance in future years.
Read the full CMS Fact Sheet here:
Remember, Anesthesia Billing is hard. Fusion Anesthesia is here to help. If your anesthesia practice needs help with the No Surprise Act, Contact Fusion Anesthesia Solutions with any questions.