CMS Releases Frequently Asked Questions Regarding the No Surprises Act

In April 2022 CMS provided answers to several frequently asked questions on issues regarding the No Surprises Act.  

In the FAQs for providers about the No Surprises rules, CMS provides clarification on exceptions to the requirements under the No Surprises Act and questions regarding the independent dispute resolution process.  

• Q2: I  want more information on provider and facility requirements. Are there any exceptions?

On page 3, CMS clarified “For purposes of these protections, health care facilities include: hospitals, hospital outpatient departments, critical access hospitals, and ambulatory surgical centers. These protections do not apply to other types of health care facilities, such as urgent care centers.”

• Q5: What types of providers do the No Surprises requirements apply to?

On page 9, CMS states “When assessing whether a No Surprises requirement applies to a particular provider, it is important to look at how the provider practices, rather than the provider’s specialty type, license, or certification.”

The FAQ about Good Faith Estimates (GFE) for Uninsured (or Self-Pay) Individuals – Part 2 provides additional answers about providing a good faith estimate to the uninsured and self-pay patients.  

• Q1: Must a GFE include a diagnosis code?

On page 1, CMS commented “No. A provider or facility is required to provide a diagnosis code only where one is required for the calculation of the GFE.”

• Q5: Is a provider or facility required to provide a GFE to uninsured (or self-pay) individuals upon scheduling same-day (or walk-in) items or services?

On page 3, CMS responded “No” and provided the following example “For example, if an uninsured (or self-pay) individual arrives to schedule same-day laboratory testing services, the laboratory testing provider or facility is not required to provide the individual with a GFE.”

For more information visit the XiFin No Surprises Act Resource Center which includes FAQs, Complimentary Webinars, NSA industry news and resources from industry experts.

Source: https://www.cms.gov/nosurprises