Index

• Sections
  • The “No Surprise” Billing Regulations for Behavioral Health Care Providers
  • When did this occur?
  • Why was it created
  • Who does the law apply to?
  • How does this affect you as a behavioral health clinician?
  • How do I tell my clients about the anticipated cost of service?
  • Additional Information

The “No Surprise” Billing Regulations for Behavioral Health Care Providers

When did this occur?

The No Surprises Act was included in the Consolidated Appropriations Act, in 2021.  Finalized on October 7, 2021, this new requirement will go into effect on January 1st of 2022. 

Why was it created

It was created to increase and improve pricing transparency and decrease the probability of consumers being surprised by a medical bill. 

Who does the law apply to?

The law extends to all health care clinicians and institutions, provided they are licensed, certified, or recognized by the state.

How does this affect you as a behavioral health clinician?

Providers of behavioral health services are legally obligated to inform clients of the anticipated cost of service prior to the service being performed and 

upon their request. Therefore, after a patient has booked an appointment, or at their request, a good-faith estimate must be issued. It should contain anticipated prices for the service they're receiving, as well as any other services included in the same planned appointment or encounter.

How do I tell my clients about the anticipated cost of service?

Using ICANotes, you can create forms in two different areas. The first is the form builder, which is available with the premium portal. You are able to create a form listing your anticipated cost of service and have the client sign this form via the patient portal. This process is effective when having clients that are seen via telehealth. You can utilize the form builder in ICANotes to create your form for in-person visits. Your clients can sign using the capture signature device. Below we have included instructions on how to use both methods. While electronic documents and signatures are time-saving, you can utilize paper forms and upload these into ICANotes. Attached is a PDF that has the standard notice and consent documents provided by CMS under the no surprises act. 

Additional Information

The No Surprises Act of 2021 is intended to protect consumers from unexpected medical bills. Many clinicians are unsure whether it applies to the services they provide. The short answer is more than likely yes. It is essential to understand why this new law has come to fruition and what you need to do to comply. 

Typically, when a person with health insurance coverage seeks care from an out-of-network provider, their insurance does not cover the full out-of-network cost. This results in higher costs than if an in-network provider had treated them. In addition, many times it is difficult for a patient or client to determine what healthcare provider or hospital is in their network. This is especially true in emergency situations. Unless state law prohibits it, an out-of-network provider can usually bill the person for any difference between the billed charge and the amount paid by their health plan. This is called "balance billing," and it leaves many patients with a "surprise bill." 

Many people have asked if this law applies to insured or non-insured, and the short answer is both. In accordance with the regulation, health care expenses must be made known to a patient or client before they receive them. The ruling also ensures that patients will be able to contest a charge if it is much larger than anticipated. The contesting can be done through a third party called an "Independent Dispute Resolution Entity." 

Clinicians are wondering what they should do to abide by the No Surprise Act, and we have some resources that may be helpful to you. In accordance with the Act, healthcare providers and facilities must inform patients that receiving care out-of-network may be more expensive and offer options for avoiding balance bills. Additionally, for individuals that do not have insurance, "good faith" estimates are required. The estimates provide a ballpark figure of what the patient's treatment will cost before they receive it. 

The onus falls on the clinician to inquire about the patient's insurance coverage; this then determines whether the care provided is out of network or if the client is self-pay. Good faith estimates should be provided to all patients, and this can be done in an electronic format via a patient portal or on paper if requested. The estimate should be in an easy-to-read and understandable format. If you have a website, you can post your fees on the website, for example. Some practices are posting their fees at the reception area and even in individual patient care areas. You could then ask your patient if they have seen your fee schedule and confirm this with them verbally. According to the mandate, you should provide a written good-faith estimate of charges as well. 

Clinicians are all too familiar with the HIPAA notification that has to be provided to patients prior to service. The Good Faith Estimate should also be provided in the same manner. The information should be personalized, such as the patient identifiers, clinician identifiers, and billing rates. A customer should receive a new list every year, especially if you have had rate changes. 

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