The No Surprises Act

Although you may be aware of this Act, it may have important implications for psychologists, social workers, counselors, and therapists, especially when many are moving away from working only with clients whose insurance may dictate charges. Here are links to relevant information from The American Psychological Association:

New billing disclosure requirements take effect in 2022 and Understanding the No Surprises Act: How to provide estimates for your services. For detailed answers to frequently asked questions regarding compliance with the No Surprises Act and how to generate good faith estimates, please visit the FAQs on the No Surprises Act and good faith estimates page.

Instructions for simple Good Faith Estimate template

You can modify this form to be the Good Faith Estimate (GFE) form for your practice if you are not required to, or will not be, including estimates for providers outside of your practice (FAQs on the No Surprises Act and good faith estimates).

This is designed for situations where only one provider in your practice is expected to provide services to a particular patient. But you can modify it to add the names, NPI, and TIN of multiple providers in your practice to the section on psychologist providing services.

Important notes about dispute resolution: 

This form provides a slightly simplified version of the disclaimer language in the much longer CMS template. We think that language may be confusing to patients because it suggests that a patient could initiate the dispute resolution process if your billing exceeds your current GFE by any amount. However, the GFE regulations make it clear that dispute resolution is only available if it is $400 higher. 

As explained in Understanding the No Surprises Act, it is important to track your billing vs. GFEs to avoid reaching the point where your billing is $400 over the GFE. If you nonetheless find yourself in that position, we recommend that (in addition to promptly updating your GFE), you talk to your patient. We expect that most patients will understand, particularly while the GFE requirements are new. 

If, however, your patient is upset or angry and wants to pursue dispute resolution, you should consider whether making a patient go through that process, like taking collection action against a patient, is worth the risk of triggering a board complaint or negative online review.