1 SEPTEMBER7,2022 j our nale TheDefinitive QuestionAnd Answer Guide ExplainingThe NoSurprises Act TheNo Surprises Act A CorroHealth Company Quest ions (andAnswers) Inside 20
You're not alone. In this special issue of the eJournal we've assembled 20 quest ions from the hundreds of inquiries received during our No Surprises Act Webinars. If you've never attended one of our free webinars, never fear. There's anot her one scheduled right around t he corner. Registering is easy. Just scan the QRCode and sign up. Then get ready for some great information that will prepare you for what's ahead.
2 PARA Weekly eJournal: September 7, 2022 NO SURPRISES ACTQUESTIONSAND ANSWERS HastheNoSurprises Act got youwondering, dazed,confused, befuddled,bewildered anddownright perplexed?
The convening provider or facility is the provider or facility that is responsible for scheduling the primary items or services. Other providers or facilities that furnish items or services in conjunction with the primary item or service furnished by the convening provider or facility are considered ?co-providers?and ?co-facilities ?
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No later than one business day after scheduling the primary item or service or receiving a request for a GFE, the convening provider or facility must contact all co-providers and/or co facilities that will provide items or services in conjunction with the primary items or services and request GFEinformation including the expected charges for these items or services expected to be provided by the co provider or co facility.
Quest ion: What happens if m ore t han one provider or facilit y is involved in providing a prim ary it em or service t o an uninsured (or self pay) individual?
NO SURPRISES ACTQUESTIONSAND ANSWERS
Answ er: In instances where multiple providers might be responsible for furnishing care in conjunction with a primary item or service, the ?convening provider or facility?must provide a GFEto the uninsured (or self pay) individual, which includes items or services reasonably expected to be furnished by the convening provider or facility, and items or services reasonably expected to be furnished by co-providers or co-facilities.
Answ er: HHSwill exercise its enforcement discretion in situations where a GFEprovided to an uninsured (or self-pay) individual does not include expected charges from co-providers or cofacilities. In a similar question answered by CMSin an FAQ published 12/21/2021, CMS encourages convening providers and facilities to include a range of expected charges for items or services expected to be provided and billed by co-providers and co-facilities. PARA?s NSA tool allows for the inclusion of co providers?contact information so the uninsured individual can contact those providers directly to request a GFE
We understand that it may take time for providers and facilities to develop systems and processes for receiving and providing the required information from co providers and co facilities 1 45 CFR149 610(a)(2) 3 Therefore, for GFEs provided to uninsured (or self pay) individuals from January 1, 2022 through December 31, 2022, HHSwill exercise its enforcement discretion in situations where a GFEprovided to an uninsured (or self pay) individual does not include expected charges from co providers or co facilities
Quest ion: If co provider did not provide t he GFE t o convening provider, can convening provider not give t he co provider 's GFE?
PARA Weekly eJournal: September 7, 2022
We note that nothing prohibits a co provider or co facility from furnishing the GFEinformation to the convening provider or facility before December 31, 2022, and nothing would prevent the uninsured (or self pay) individual from separately requesting a GFEdirectly from the co provider or co facility, in which case the co provider or co facility would be required to provide the GFEfor such items or services
NO SURPRISES ACTQUESTIONSAND ANSWERS
Otherwise, during this period (January 1, 2022 through December 31, 2022), we encourage convening providers and facilities to include a range of expected charges for items or services expected to be provided and billed by coproviders and co facilities
Answ er: In the Interim Final Rules, Part 1, HHSwas considering allowing the disclosure notice to be given annually The final decision was to give the notice when it will have the most influence Giving the Disclosure at the beginning of a series of 10 treatments would be effective in informing the patient of their rights under the NSA.
These disclosures are critical to helping raise awareness and enhance the public's understanding of state and federal balance billing protections. The purpose of these disclosures is to empower individuals to better understand the balance billing protections afforded under applicable state and federal law. In addition, these disclosures are important in ensuring individuals are able to identify violations of these interim final rules and related state law requirements and, if necessary, file complaints against providers and facilities
Quest ion: If w e have pat ient s com ing in for infusions every day for 10 days in a row , w e only regist er t he pat ient one t im e and have t hem sign one consent for t he durat ion of t he infusions How ever, w e do subm it individual claim s for each DOS Do w e need t o provide t hem t he Disclosure Not ice every day t hey com e in or w ould one disclosure not ice suffice in t his case?
Federal Regist er :: Requirem ent s Relat ed t o Surprise Billing; Part I
In developing these interim final rules, HHS considered allow ing providers or facilities to provide the disclosure annually or only at the time a patient schedules a service, but wanted to ensure the timing of the disclosure was relevant to when the individual may experience a violation of the surprise billing protections. HHSencourages providers and facilities to provide individuals with the notice at a time that will maximize the notice's effectiveness.
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PARA Weekly eJournal: September 7, 2022
The disclosure notice must be limited to one, double-sided page and must use a 12 point font size or larger.
Providers and facilities must issue the disclosure notice no later than the date and time they request payment from the individual (including requests for copayment or coinsurance made at the time of a visit to the provider or facility). If the provider or facility doesn? t request payment from the individual, they must provide the notice no later than the date they submit a claim for payment to the plan or issuer Quest ion: We have a clinic t hat w e offer t o em ployed individuals t hat w e pay $25 t o be seen for sick visit s. All have our hospit al insurance and claim s are subm it t ed t o t hem for w ellness visit s and t here is no cost t o em ployees for t hose Would w e need t o provide t he Disclosure Not ice t o t hose em ployees w ho ut ilize t his clinic since t hey are covered by t he hospit al group healt h plan?
Answ er: All individuals covered by a group health plan, and requesting that a claim be submitted to that plan, must receive a Disclosure Notice before the provider can request co-pays, or if not requesting a co-pay, before a claim is submitted to the plan.
(3) With respect to the required disclosure to individuals who are participants, beneficiaries, or enrollees of a group health plan or group or individual health insurance coverage offered by a health insurance issuer, a provider or facility must provide the information described in paragraph (b) of this section in a one page (double sided) notice, using print no smaller than 12 point font The notice must be provided in person or through mail or email, as selected by the participant, beneficiary, or enrollee
eCFR :: 45 CFR 149 430 Provider and facilit y disclosure requirem ent s regarding pat ient prot ect ions against balance billing Required methods for disclosing information Health care providers and health care facilities must provide the disclosure required under this section as follows:
(1) With respect to the required disclosure to be posted on a public website, the information described in paragraph (b) of this section, or a link to such information, must appear on a searchable homepage of the provider's or facility's website A provider or facility that does not have its own website is not required to make a disclosure under this paragraph (c)(1)
(2) With respect to the required disclosure to the public, a provider or facility must make public the information described in paragraph (b) of this section on a sign posted prominently at the location of the provider or facility A provider that does not have a publicly accessible location is not required to make a disclosure under this paragraph (c)(2).
(d) Timing of disclosure to individuals. A health care provider or health care facility is required to provide the notice to individuals who are participants, beneficiaries, or enrollees of a group health plan or group or individual health insurance coverage offered by a health insurance issuer no later than the date and time on which the provider or facility requests payment
NO SURPRISES ACTQUESTIONSAND ANSWERS
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Providers and facilities must provide the notice in person, by mail, or by email, as selected by the individual
A health care provider or health care facility is required to provide the notice to individuals who are participants, beneficiaries, or enrollees of a group health plan or group or individual health insurance coverage offered by a health insurance issuer no later than the date and time on which the provider or facility requests payment from the individual, or with respect to an individual from whom the provider or facility does not request payment, no later than the date on which the provider or facility submits a claim to the group health plan or health insurance issuer.
Quest ion: Is t his present at ion available t o dow nload? Answ er: All Q&A documents and recorded webinars can be found on the Bulletin Board at w w w.pararevenue.com NO SURPRISES ACTQUESTIONSAND ANSWERS
Timing of disclosure to individuals
6 PARA Weekly eJournal: September 7, 2022 (d)
addressingthat most employer policieshavea definedcopay or deductiblethat appliesto out of network. If webill thepatient the defined"out of network" amount (not balance billing),dowehaveto provideany noticeto them? Thiswouldbemorethan thein-network ratebut it isdefinedby the plan/policy. Thisisaquestionthat AHA and HFMA haveposedtoCMSandthe tri-agenciesandareawaiting clarification. Onasimilar note,inatierednetwork, theprovider isconsideredinnetwork at all levels,andthereforethebanon balancebillingandconditionson cost-sharingtothein-network amount provisionsdonot apply. Any cost-sharingfor tier 1 or tier 2 providerswouldbein-network and not applicabletoNoSurprises...so althoughnot real helpful onyour direct question...hopingthismay help youor someoneelse.
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Quest ion: Now here is anyone addressing t hat m ost em ployer policies have a defined copay or deduct ible t hat applies t o out -of-net w ork If w e bill t he pat ient t he defined "out of net w ork" am ount (not balance billing), do w e have t o provide any not ice t o t hem ? This w ould be m ore t han t he in net w ork rat e but it is defined by t he plan/ policy.
Answ er: This is a question that AHA and HFMA have posed to CMSand the tri-agencies and are awaiting clarification. On a similar note, in a tiered network, the provider is considered in network at all levels, and therefore the ban on balance billing and conditions on cost sharing to the in network amount provisions do not apply Any cost sharing for tier 1 or tier 2 providers would be in-network and not applicable to No Surprises... so although not real helpful on your direct question... hoping this may help you or someone.
NO SURPRISES ACTQUESTIONSAND ANSWERS
Nowhereisanyone
Quest ion: I am a lit t le unclear on ancillary services st ill If a pat ient schedules at an OON facilit y and is non-em ergent , can w e balance bill ancillary?
Answ er: This is correct, with the exception of emergent care For emergent items and services provided at any facility, emergent care out of network balance billing is prohibited However, for scheduled out-of-network services, an out-of-network convening provider with an out of network co provider or co facility is not required to provide a consent or a good faith estimate before balance billing a patient for out of network items or services this would not be a "surprise" since the patient sought care at an out of network convening provider/facility
Quest ion: I had a com plet ely different underst anding of one of your first point s and w ould appreciat e confirm ing w hat I heard. If t he facilit y and t he provider are bot h out of net w ork, e g w e don't accept X insurance at all no consent is required? Not even a confirm at ion t o t he pat ient so t hey know t he facilit y is OON? EG OP hospit al specialist bot h don't accept insurance - no consent required?
Quest ion: Please confirm t hat NSBA does not apply in sit uat ions w here t he facilit y and provider(s) are out of net w ork
Answ er: Under the No Surprise Act provisions related to non emergent items or services scheduled at an out of network facility with an out of network provider, at this time, a notice and consent along with a good faith estimate is not required under the Act provisions. That is not to say that it is not a best practice to provide an estimate for what the patient will owe when seeking non emergent care at an out of network facility with an out of network provider
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NO SURPRISES ACTQUESTIONSAND ANSWERS
Answ er: Yes The No Surprises Act provisions do not apply to scheduled services at out-of-network facilities, only to in-network facilities with an out-of-network provider performing the service.
Answ er: Time frames are based on when the service is scheduled There are no exceptions to the severity of the case or how it is identified as a needed service.
Quest ion: Is t here any exclusions in t he event t he service is an urgent case? For exam ple, a self-pay pat ient having an urgent surgery t hat is scheduled m ore t han 3 days out ? Do t he t im e fram es st ill apply regardless?
Quest ion: If physician's office draw s blood and sends t o t he lab t o be t est ed w ho should provide t he GFE t o pat ient ? Does physician's office provide GFE t o pat ient in t his sit uat ion?
Answ er: The GFEis provided to the patient by the convening provider. The convening provider is described as the provider who is scheduling the service. If the office is scheduling the patient for the Lab draw at least 3 business days in advance, and will be billing the patient for the Labs, the office must include the Lab charges on the GFE eCFR :: 45 CFR Part 149 Subpart G Prot ect ion of Uninsured or Self Pay Individuals
Convening healt h care provider or convening healt h care facilit y (convening provider or convening facilit y) means the provider or facility who receives the initial request for a good faith estimate from an uninsured (or self pay) individual and who is or, in the case of a request, would be responsible for scheduling the primary item or service (iii) Co-health care provider or co-health care facility (co-provider or co-facility) means a provider or facility other than a convening provider or a convening facility that furnishes items or services that are customarily provided in conjunction with a primary item or service Requirem ent s of providers and facilit ies (1) Requirements for convening providers and convening facilities. A convening provider or convening facility must determine if an individual is an uninsured (or selfpay) individual by: (i) Inquiring if an individual is enrolled in a group health plan, group or individual health insurance coverage offered by a health insurance issuer, Federal health care program (as defined in section 1128B(f) of the Social Security Act), or a health benefits plan under chapt er 89 of t it le 5, Unit ed St at es Code; (ii) Inquiring whether an individual who is enrolled in a group health plan, or group or individual health insurance coverage offered by a health insurance issuer or a health benefits plan under chapt er 89 of t it le 5, Unit ed St at es Code is seeking to have a claim submitted for the primary item or service with such plan or coverage; and (iii) Informing all uninsured (or self pay) individuals of the availability of a good faith estimate of expected charges upon scheduling an item or service or upon request; information regarding the availability of good faith estimates for uninsured (or self-pay) individuals must be: (A) Written in a clear and understandable manner, prominently displayed (and easily searchable from a public search engine) on the convening provider's or convening facility's website, in the office, and on-site where scheduling or questions about the cost of items or services occur;
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NO SURPRISES ACTQUESTIONSAND ANSWERS
Answ er: NSA Only Users have access to the Extract/Table 2 to create Custom Claims.
SURPRISES
ANSWERS
m ult iple
(iv) Convening providers and convening facilities shall consider any discussion or inquiry regarding the potential costs of items or services under consideration as a request for a good faith estimate; (v) Upon the request for a good faith estimate from an uninsured (or self pay) individual or upon scheduling a primary item or service to be furnished for such an individual, the convening provider or convening facility must contact, no later than 1 business day of such scheduling or such request, all co-providers and cofacilities who are reasonably expected to provide items or services in conjunction with and in support of the primary item or service and request that the co providers or co facilities submit good faith estimate information (as specified in paragraphs (b)(2) and (c)(2) of this section) to the convening provider or facility; the request must also include the date that good faith estimate information must be received by the convening provider or facility; (vi) Provide a good faith estimate (as specified in paragraph (c)(1) of this section) to uninsured (or self pay) individuals within the following time frames:
Quest ion: Do NSA Only users have t he opt ion of adding addit services? Can NSA Only users provide est at es for services on
NO ACTQUESTIONSAND
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ional
(B) Orally provided when scheduling an item or service or when questions about the cost of items or services occur; and (C) Made available in accessible formats, and in the language(s) spoken by individual(s) considering or scheduling items or services with such convening provider or convening facility.
(A) When a primary item or service is scheduled at least 3 business days before the date the item or service is scheduled to be furnished: Not later than 1 business day after the date of scheduling; (B) When a primary item or service is scheduled at least 10 business days before such item or service is scheduled to be furnished: Not later than 3 business days after the date of scheduling; or (C) When a good faith estimate is requested by an uninsured (or self pay) individual: Not later than 3 business days after the date of the request
one GFE?
im
Quest ion: At t his t im e w hen t hey call for an est im at e is it only for t he uninsured t hat w e are required t o prepare t he GFE or for insured as w ell?
Quest ion: Suppose a provider or facilit y did not provide an individual w it h a GFE at t he t im e t he individual scheduled an it em or service because she w as not uninsured (or self-pay) at t hat t im e, but w hen she arrives for t he scheduled it em or service t o be furnished, her insurance st at us has changed such t hat she is now uninsured (or self pay).
Must t he provider or facilit y provide a GFE t o t he individual prior t o providing t he it em or service, even if it m eans rescheduling t he it em or service for a lat er dat e?
For individuals who, at the time of scheduling or request, are not uninsured (or selfpay), HHShas indicated in guidance that it will defer enforcement of the requirement under PHSAct section 2799B?6, as added by section 112 of division BB of the CAA, that providers and facilities provide a GFEto such individual?s plan or coverage, until rule making to implement this requirement is adopted and applicable 3 This means that until further rule making to implement this requirement is adopted and applicable, HHSwill not enforce against providers and facilities that do not provide GFEs to plans and issuers for individuals who are not uninsured (or self pay), as defined in 45 CFR 149 610(a)(2)(xiii), at the time the individual schedules or requests the GFEfor the items or services expected to be furnished. We encourage providers and facilities to inform patients when scheduling items or services or responding to a request for a GFEthat they should contact their provider if any information related to their appointment, including their insurance status, changes in advance of the appointment, so that a new GFEcan be provided, if necessary.
Answ er: No When an individual schedules an appointment with a provider or facility, or upon request, the provider or facility must inquire if the individual is uninsured (or selfpay) If the individual is uninsured (or-self pay) at that time, the provider or facility must provide a GFEto the individual consistent with the requirements in 45 CFR149.610.
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Answ er: The NSA provision for a GFEis only required for uninsured patients or those who will not be submitting a claim (self pay) Insured individuals can be directed to (or assisted with using) the Price Transparency Tool (PTT) to determine the cost of services.
In situations where a provider or facility who has previously determined that an individual was not uninsured (or selfpay) becomes aware that an individual is uninsured (or selfpay) fewer than 3 business days in advance of the scheduled furnishing of items or services, nothing in the GFE regulations at 45 CFR149 610 require that the provider or facility provide a GFEto such an individual, or reschedule an appointment to allow for the provision of a GFEto such an individual.
NO SURPRISES ACTQUESTIONSAND ANSWERS
Quest ion: Will you be adding a ?Port al? opt ion along w it h Mail and Em ail?
Answ er: Billed charges should reflect the services provided It?s not necessary to keep the billed charges under $400 if they can be justified as medically necessary and could not have been anticipated in advance. The GFEis only as estimate of reasonably expected charges. There is a disclaimer that informs the patient that billed charges may exceed the estimate Not all bills exceeding the $400 threshold will be disputed The patient will initiate the dispute if they choose
Quest ion: For facilit ies w it h m ult iple locat ions can w e m anually change t he address on t he GFE?
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Answ er: That request will be taken into consideration.
Quest ion: Are any providers set t ing up a unique ins plan code w here a GFE has been provided t o cont rol billing for m ore t han $400? Any ot her syst em flags you use t o m anage t hese pat ient encount ers?
Answ er: This request has been submitted to the Development team for discussion. The provider information is pulled by NPI number so multiple locations cannot be associated with one NPI. Any manual address changes will be saved and could potentially result in an incorrect address on future GFEs More information will be provided after the Development team finds a good resolution
NO SURPRISES ACTQUESTIONSAND ANSWERS
Answ er: The requirements of the No Surprises Act, including the requirement to provide a good faith estimate to uninsured or self-pay patients, do not apply to individuals enrolled exclusively in Medicare. The Medicare program has its own protections against surprise bills.
Answ er: If the catastrophic plan is through a health plan in which the facility has a contract, yes, they can bill the full amount as patient liability. If they don? t have a contract, yes, they can bill the full amount because OON patients have no protections under the No Surprises Act.
Quest ion: Does t he GFE need t o include any "fut ure" visit s/ services t hat m ay reasonably be expect ed w it h t he prim ary service?
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Answ er: This question has been submitted to CMSfor clarification The GFEdata elements list future services as a requirement yet the template for the GFE, which CMSstates meets compliance, does not allow for entry of charges for future visit Will update when CMSresponds
Quest ion: Pat ient has cat ast rophic plan only (not show n t hrough eligibilit y, not com m unicat ed by insurance prior t o scheduled procedure) Hospit al called payor t o obt ain aut h for hem orrhoidect om y, but insurance st at ed no aut horizat ion w as needed. EOB cam e in as non covered procedure. Can t he hospit al bill pat ient ?
Quest ion: Several t im es in t he NSA it is m ent ioned t hat Medicare beneficiaries are not affect ed by t he NSA because Medicare has prot ect ions in place. I am request ing clarificat ion on t hose Medicare services t hat are st at ut orily excluded, covered under t he HINN and covered by an ABN These services are t echnically being supplied as self pay services Are t he HINN and ABN form s enough t o prot ect t he Medicare beneficiary or w ould t hey qualify for a GFE as a self-pay service? Response received on 04/ 18/ 2022
NO SURPRISES ACTQUESTIONSAND ANSWERS
Quest ion: Can w e updat e our uninsured discount or does PARA have t o do t his? Answ er: PARA must make those changes.
14 PARA Weekly eJournal: September 7, 2022 This is it .Par aRev hascompl et ely updat edit s Compr ehensive COVID-19Guide.TheGuidecontains detail edinfor mat ionabout bil l ingandcoding,t est ingandot her guidancer el at edt oCOVID-19. It's online. You can download it by clicking the image to the right, or by clicking the URL here: https://apps.parahcfs.com/para/ Documents/ 2022%20Comprehensive% 20Covid-19%20Guide pdf COMPLETELY UPDATED: COMPREHENSIVECOVID 19 GUIDE
15 PARA Weekly eJournal: September 7, 2022 MLN CONNECTS PARA invit es you t o check out t he m lnconnect s page available from t he Cent ers For Medicare and Medicaid (CMS) It 's chock full of new s and inform at ion, t raining opport unit ies, event s and m ore! Each w eek PARA w ill bring you t he lat est new s and links t o available resources Click each link for t he PDF! Thursday, Sept em ber 1, 2022 New s CORRECTION: Monkeypox & Smallpox Vaccines: Include Product Code on Claims - COVID-19: Novavax Vaccine Authorized for Patients 12?17 Years Old Medicare Shared Savings Program Saves Medicare More Than $1 6 Billion in 2021 & Continues to Deliver High quality Care - Increased Use of Telehealth for Opioid Use Disorder Services During COVID-19 Pandemic Associated with Reduced Risk of Overdose Sickle Cell Disease: What You Need to Know Video - Healthy Aging: Recommend Services for Your Patients Com pliance DMEPOSStandard Written Order Requirements Claim s, Pricers, & Codes Influenza Vaccine Payment Allowances Annual Update for 2022?2023 Season Quarterly Update to Home Health (HH) Grouper Mult im edia Introduction to Language Access Plans Web Based Training Combating Medicare Parts Cand D Fraud, Waste, & Abuse Web Based Training ? Revised Inform at ion for Pat ient s - How to Report a Medicare Complaint
16 PARA Weekly eJournal: September 7, 2022 Therew ereFIVEnew or revised Transmittalsreleased thisw eek. To go to thefull Transmittal document simply click on thescreen shot or thelink. 5 t r ans mit t al s
17 PARA Weekly eJournal: September 7, 2022 TRANSMITTAL R11582OTN
18 PARA Weekly eJournal: September 7, 2022 TRANSMITTAL R11583CP
19 PARA Weekly eJournal: September 7, 2022 TRANSMITTAL R11585OTN
20 PARA Weekly eJournal: September 7, 2022 TRANSMITTAL R3P2R7I
21 PARA Weekly eJournal: September 7, 2022 TRANSMITTAL R11584OTN
22 PARA Weekly eJournal: September 7, 2022 1 m edl ear ns Therew asONEnew or revised MedLearnsreleased thisw eek. To go to thefull Transmittal document simply click on thescreen shot or thelink.
23 PARA Weekly eJournal: September 7, 2022 MEDLEARN MM12822
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