BC Advantage - 2022 Issue 4
No Surprises Act Compliance
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Article Overview
This article explains the No Surprises Act compliance framework as it applies to certain health plans, providers, and facilities. It is geared toward compliance staff, administrators, and health law professionals who need a high-level understanding of notice and consent requirements, good faith estimate processes, and public disclosure expectations, along with the role of CMS-provided forms and federal implementation guidance.
Why This Topic Matters
The article helps readers understand the core compliance areas involved in avoiding balance billing-related violations and preparing facility policies, patient notices, and public-facing disclosures under the No Surprises Act.
Article Sections
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Overview of the No Surprises Act
Introduces the federal law, its effective date, and the general compliance focus of the article. Summarizes the categories of services and settings affected at a high level.
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Notice and Consent
Describes the notice-and-consent framework for certain non-emergency situations and the related timing, language, and documentation considerations. Also notes CMS-issued form resources and exceptions discussed in the article.
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Good Faith Estimates
Covers the obligation to provide estimated cost information and the circumstances in which estimates are addressed for different patient categories. Includes general discussion of multi-provider notices and CMS model form use.
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Public Disclosure
Explains the requirement to make patient protection information publicly available and the general content of the required notice. Also references website posting and agency contact information.
What You Will Learn
- Which organizations and service settings are addressed by the No Surprises Act compliance discussion
- What broad notice and consent procedures are discussed for affected services
- What the article says about good faith estimates and related patient-facing information
- What kinds of public disclosure obligations are described for providers and facilities
- Which CMS forms and federal guidance resources are referenced at a high level
Who Should Read This
- Compliance officers
- Health care administrators
- Revenue cycle staff
- Health law professionals
- Facility managers
- Provider practice managers
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