Congress enacted the No Surprises Act (the Act) to protect patients from costly, unexpected medical bills. The regulation applies to all health care providers, which the Centers for Medicare & Medicaid Services (CMS) defines 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.” This means that the new regulation applies to both audiology and speech-language pathology providers. However, the provision only applies to patients without insurance who are self-paying or insurance where the provider is considered out-of-network.
No Surprises Act Impact on Audiology and Speech-Language Therapy Services
The regulation includes a provision for Good Faith Estimates, which informs patients of the cost of care they will be receiving before their appointment. This is the portion of the regulation that will impact audiology and speech-language pathology the most. Beginning January 1, 2022, audiologists, and speech-language pathologists (SLP) are required by law to provide a Good Faith Estimate to every new and established patient who is either seeking treatment as a self-pay patient or is considered out-of-network with you as a provider. A Good Faith Estimate is the best judgment of the cost of care a provider plans to offer to the patient across the episode of care.
To protect patients, the law also requires that the provider’s Good Faith Estimate must be within $400 of the actual charge(s) to the individual for the service(s) you provided. The threshold for “substantially in excess” means that the estimate exceeded the expected charges by at least $400 of what was provided in the Good Faith Estimate. If this occurs, a patient who is self-paying or not using insurance has the right to challenge the bill through a dispute resolution process. The “substantially in excess” provision applies to the per visit cost as opposed to the total plan of care cost. Best practices for your Good Faith Estimate would be to list your price per visit for the evaluation and your price per visit for each of the individual’s follow-up visits. Share the expected range of follow-up visits and consider adding a total expected cost range.