No Surprises Act

The CSW wants to help you understand the “No Surprises Act”, which went into effect on January 1, 2022, and what this means for you and your practice.

What is the "No Surprises Act"?
The “No Surprises Act” requires that patient cost-sharing, such as copayments, co-insurance, or a deductible cannot be higher than if such services were provided by an in-network provider, and any cost-sharing obligation must be based on in-network provider rates. This act prohibits out-of-network charges for items or services provided by an out-of-network provider at an in-network facility, unless providers and facilities provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill the patient more than in-network cost-sharing rates. This Act also addresses providing a Good Faith Estimate through notice and consent to patients considered uninsured or self-pay.

This new Act has specific requirements that are easy to implement. This Act affects both cash based and insurance based practices, so it is vital that all CSW members fully understand the data and implement it into their practices.

"No Surprises Act" Webinar and Resources

The CSW retained the top expert, Dr. Scott Munsterman to present a webinar to help our members understand the ins and outs of this new act. This webinar was held live on January 11; however, the webinar recording is available to view at your leisure. To ensure this information is a clear as possible, Dr. Munsterman has also allowed viewing of his slide presentation which includes a link to a list of resources where you may find forms and templates that you can implement in your office.

Watch the webinar
To adress followup questions from the webinar, the CSW created a questions and answers page from the questions we received post-event. You can view the Q&A by clicking the link above.

FAQS About Consolidated Appropriations Act, 2021 Implementation - Good Faith Estimates (GFE) For Uninsured (Or Self-Pay) Individuals - Part 2

Please click the link above to view the Frequently Asked Questions (FAQs) regarding implementation of Section 112 of Title I (the No Surprises Act (NSA)) of Division BB of the Consolidated Appropriations Act, 2021 (CAA 2021), and implementing regulations published in the Federal Register on October 7, 2021 as part of interim final rules with comment period, entitled “Requirements Related to Surprise Billing; Part II.” These FAQs were prepared by the Department of Health and Human Services (HHS) to address the provision of GFEs for uninsured (or self-pay) individuals, as described in Public Health Service Act (PHS Act) section 2799B-6 and implementing regulations at 45 CFR 149.610.

Additional questions can be addressed to [email protected].