No Surprises Act?

[foreverbull]

PP folks, wondering if you have any thoughts on the No Surprises Act?

New billing disclosure requirements take effect in 2022

Beginning January 1, 2022, psychologists and other health care providers will be required by law to give uninsured and self-pay patients a good faith estimate of costs for services that they offer.

www.apaservices.org

I'm surprised that there hasn't been much dialogue about this, from what I've seen.

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[AbnormalPsych]

There is a lot of confusion from the listservs I am on.

Here is something from the Trust:

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parma.trustinsurance.com

 

[AcronymAllergy]

PP folks, wondering if you have any thoughts on the No Surprises Act?

New billing disclosure requirements take effect in 2022

Beginning January 1, 2022, psychologists and other health care providers will be required by law to give uninsured and self-pay patients a good faith estimate of costs for services that they offer.

www.apaservices.org

I'm surprised that there hasn't been much dialogue about this, from what I've seen.

There's an ongoing thread in the Psychiatry forums on this; maybe fewer folks here are in PP?

I've seen numerous emails across listservs I'm on. Like AbnormalPsych said above, I've seen a lot of confusion and uncertainty. The main themes I've gathered are: 1) there's confusion about who's actually required to do this, 2) people are uncertain when enforcement will begin and what potential penalties there might be (up to and including some folks thinking it's unenforceable to begin with), and 3) most providers do something like this already but have adjusted their forms to be more in line with the templates APA has offered.

 

[WisNeuro]

There's an ongoing thread in the Psychiatry forums on this; maybe fewer folks here are in PP?

I've seen numerous emails across listservs I'm on. Like AbnormalPsych said above, I've seen a lot of confusion and uncertainty. The main themes I've gathered are: 1) there's confusion about who's actually required to do this, 2) people are uncertain when enforcement will begin and what potential penalties there might be (up to and including some folks thinking it's unenforceable to begin with), and 3) most providers do something like this already but have adjusted their forms to be more in line with the templates APA has offered.

Yeah, my consent forms already include my hourly rates and anticipated time to do the eval (of which I always estimate on the high end). According to the APA guidance, I only have to make some small tweaks to be in compliance. But, at least clinically, my patients are almost all insured, so no big changes there. And, on the legal sides of things, this does not apply, so nbd there.

 

[foreverbull]

Update: after many hours of reading up on this Act, I’ve finally implemented it for my practice. If anyone in private practice needs additional info or support to fully implement it (it’s not just about creating a Good Faith Estimate form, but is more involved), I’m happy to provide resources or private consulting for a small fee. PM me if interested.

Also, of note, there’s a movement to amend the act to remove psychotherapists:

Sign the Petition

Amend the No Surprises Act of 2022 regarding Private Practice Mental Health Clinicians

www.change.org

My local county psych org has also posted a template to send directly to congress members.

I’ve already found the Act to be burdensome in terms of additional admin tasks for no gain in PP. Clients are already well aware of fees in PP so this is a completely unnecessary extra step to document for each client every single year or more if you change diagnoses.

Also being forced to ask potential clients about insurance when I don’t even take it is a bit ridiculous if you ask me….

 

[Sanman]

Update: after many hours of reading up on this Act, I’ve finally implemented it for my practice. If anyone in private practice needs additional info or support to fully implement it (it’s not just about creating a Good Faith Estimate form, but is more involved), I’m happy to provide resources or private consulting for a small fee. PM me if interested.

Also, of note, there’s a movement to amend the act to remove psychotherapists:

Sign the Petition

Amend the No Surprises Act of 2022 regarding Private Practice Mental Health Clinicians

www.change.org

My local county psych org has also posted a template to send directly to congress members.

I’ve already found the Act to be burdensome in terms of additional admin tasks for no gain in PP. Clients are already well aware of fees in PP so this is a completely unnecessary extra step to document for each client every single year or more if you change diagnoses.

Also being forced to ask potential clients about insurance when I don’t even take it is a bit ridiculous if you ask me….

Good to know about the amendment. If we can't have billing parity, please exclude us from this as well.

 

[foreverbull]

I’m still thinking that most PP folks don’t even know about this. Many of my colleagues from grad school haven’t implemented it even though it was in effect January 1st. Although I understand confusion about it, this isn’t a guideline but a law.

 

[R. Matey]

I’m still thinking that most PP folks don’t even know about this. Many of my colleagues from grad school haven’t implemented it even though it was in effect January 1st. Although I understand confusion about it, this isn’t a guideline but a law.

Isn't there a grace period? I remember people talking about that on my state org listserv.

 

[WisNeuro]

Isn't there a grace period? I remember people talking about that on my state org listserv.

Yes, and no.

Understanding the No Surprises Act: How to provide estimates for your services

Psychologists and other health care providers are now required by law to give uninsured and self-pay patients a good faith estimate of costs for services that they offer.

www.apaservices.org

FAQ - No Surprises Act | January 31, 2022

What is the No Surprises Act (NSA)? The NSA was signed into law in December 2020 and was primarily intended to protect patients/clients from unexpected out-of-network bills for healthcare. The classic example is the person who obtains needed surgery at an in-network hospital, but gets a...

www.trustinsurance.com

 

[foreverbull]

Isn't there a grace period? I remember people talking about that on my state org listserv.

My understanding from the training is that the regulators acknowledge that they understand that it’s confusing, but that it’s still enforceable now, regardless. My takeaway was that we’re expected to do our best to implement it ASAP and that they’ll understand if we don’t do it perfectly, but should at least make a good faith effort to implement it.

There’s no grace period.

 

[R. Matey]

My understanding from the training is that the regulators acknowledge that they understand that it’s confusing, but that it’s still enforceable now, regardless. My takeaway was that we’re expected to do our best to implement it ASAP and that they’ll understand if we don’t do it perfectly, but should at least make a good faith effort to implement it.

There’s no grace period.

Yeah, I went through my old emails and that was an earlier interpretation by APAPS that was later defunct ¯\_(ツ)_/¯

 

[foreverbull]

Yeah, I went through my old emails and that was an earlier interpretation by APAPS that was later defunct ¯\_(ツ)_/¯

Yeah I think APA and others initially thought there was a grace period and then realized that it didn’t apply to our practices somehow?

 

[R. Matey]

Yeah I think APA and others initially thought there was a grace period and then realized that it didn’t apply to our practices somehow?

It seems like that was their initial interpretation that they may have jumped the gun on when the first emails started coming out. Wishful thinking perhaps.

 

[foreverbull]

Update: CMS plans to require psychologists and other health professionals to provide Good Faith Estimates to insurance companies if the client is using insurance. Thus, EVERY current client and prospective client with an intake scheduled or who asks about GFEs during a consultation will now need a GFE in 2023 (except for those paying by a 3rd party who is not an insurer such as Lyra, perhaps?). See the article for details and to find the link to comment on the proposed change to include insured clients.

No Surprises Act: CMS looks for input on good faith estimate requirements

The Centers for Medicare and Medicaid Services is asking for input on the way providers send information to plans, insurers, and carriers for covered patients to facilitate the Good Faith Estimate process.

www.apaservices.org

Not only is the No Surprises Act not going away, but it is about to become even more burdensome. Please comment during the comment period if you are in private practice and this will create a significant time burden for your practice.

 

[smalltownpsych]

This seems like a way to try to make our services as small private practice providers seem as confusing as what the insurance companies and Medicare does. I have had about 100 patients in the last year and when we tell them on the phone that it’s 200 for intake and 175 per session afterwards they never seem surprised when they show up and we tell what the amount is. I did make up a form for the GFE to be in compliance and it is clearly an aversive stimulus for patients to see the potential high amount of 175 x 50 for a year which I think is what is intended.