No Surprises Act Requirements: Good Faith Estimates for Uninsured and Self-Pay Patients-No Surprises Act Requirements: Good Faith Estimates for Uninsured and Self-Pay Patients

No Surprises Act Requirements: Good Faith Estimates for Uninsured and Self-Pay Patients

Video Transcription

Video Summary

In tonight's webinar, Bob Jasek and Cindy Moon discussed the requirements of the No Surprises Act and the Good Faith Estimate (GFE) for uninsured and self-pay patients. They explained that there are three types of GFEs: one for patients who waive balanced billing protections, one for insured patients, and one for uninsured or self-pay patients. They emphasized the importance of determining whether a patient is uninsured or self-pay and providing GFEs for all reasonably expected charges for these patients. The GFEs should include information about the primary item or service, as well as any other items or services that are reasonably expected to be furnished in conjunction with it. They also highlighted the content requirements for GFEs and the need to determine the status of co-providers and co-facilities. Additionally, they discussed the patient-provider dispute resolution process for cases where the charges on the bill are substantially in excess of the amounts on the GFE. They explained the requirements for initiating a dispute and the role of the Selected Dispute Resolution Entity in determining the payment amount. They also mentioned the availability of state-specific PPDR processes. Finally, they touched on the future requirements for GFEs for insured patients and the need for more information and rulemaking in this area.

Keywords

No Surprises Act

Good Faith Estimate

uninsured patients

self-pay patients

balanced billing protections

patient-provider dispute resolution

co-providers

co-facilities

Selected Dispute Resolution Entity