The "No Surprises Act" Is About to Go into Effect. Are You Ready?

Starting January 1, 2022, the "No Surprises Act" goes into effect. This piece of legislation was created to protect consumers from surprise, or balance, billing when they unknowingly see an out of network provider. This Act, on a national level, means there should be no surprise bills that arise from services rendered in an emergency department, an in-network facility or air ambulance transportation. In Massachusetts, however, the law is applicable to all out of network providers in emergent and non-emergent settings. What does this mean for an out of network provider? Patients must be informed, prior to be being seen, if the provider is out of network and what the cost of the service(s) will be. The general recommendation is to outline what, if any, insurances the provider takes and what the fee for each offered service will cost. For example, in the new patient paperwork that is sent to the patient before the initial exam, make sure a form is included stating the following:

Jonsey Smithe, LICSW is not empaneled with Harvard Pilgrim Healthcare or Allways.

Here are the fees for self-pay patients:

90791 Initial Evaluation $250

90834 45-minute therapy $150

90837 60-minute therapy $200

Providing this to your patients in advance allows them to see how much the services will cost and gives them the option to see a different provider if they cannot afford the fees. Failure to be up front about the cost of out of network services could incur penalties of up to $2500 per violation.

If you have any further questions or need assistance to ensure your practice is up to speed on the "No Surprises Act", contact us today.

Premier Medical Billing, LLC

www.premiermbma.com

617-958-6502