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No Surprises Act and Hearing Care Providers – What to Know

Hearing care legislation
On January 1, 2022, the No Surprises Act went into effect. Designed to protect patients from surprise medical bills, this law offers new protections for patients who are receiving care from out-of-network providers and at in-network facilities. It also requires that uninsured or self-pay patients be given expected costs and details of the care they will receive.

Does This Apply to You?

The No Surprises Act applies to all healthcare providers. This is defined by the Centers for Medicare & Medicaid Services as “a physician or other health care provider who is acting within the scope of practice of that provider’s license or certification under the applicable state law.”

Surprise bills often happen for patients who find themselves in emergency situations where the patient does not have time or autonomy to consider alternate options. However, that is not always the case. Sometimes these bills can occur when a patient requires services at an out-of-network provider.

The Good Faith Estimate and What It Means

Under the No Surprises Act, all self-pay, uninsured, or out-of-network patients must be provided with a good faith estimate of the cost of care. This means that, to your best judgement, you provide the patient with the cost of the services required. This must be provided in writing, signed by the patient, and included in the patient’s medical file. If cost of goods and services exceed the estimate by $400 or more then the patient will be able to dispute the bill via an independent dispute resolution (IDR).

Review Actions Taken by the Academy of Audiology

The Academy of Audiology is currently requesting a delay for the enforcement of this bill and an exemption for small practices (defined as those with 15 or fewer clinicians.) According to the Academy:

“This legislation was implemented in a hurried fashion under an interim final rule—with limited ability for stakeholder comment. The Academy will continue to provide member updates on this topic as they become available.”

Need billing or business support? CQ Partners is here to help. Contact your Account Manager with any questions on how this new bill effects your practice.