No Surprises Act: Stop Fines, Ace Self-Pay Good Faith Estimates

As of January 1st, 2022, your practice is required to comply with the No Surprises Act, which includes providing your uninsured (self-pay) patients with an “accurate Good Faith Estimate” for your services.

Sounds easy enough, right? WRONG. The federal regulations regarding how you must supply accurate Good Faith Estimates are vague and confusing, and if not done right, they leave you exposed to significant financial penalties from HHS. Penalties range from the full waiver of a patient’s bill to a fine of up to $10,000 per offense.

So, if the federal requirements are not clear on how to provide an accurate Good Faith Estimate, how are you expected to comply?

Fortunately, there is help available. During her 60-minute online training, expert and healthcare attorney, Gina L. Campanella, Esq., FACHE, will walk you through exactly how to prepare a correct, compliant Good Faith Estimate. Gina will boil down the Good Faith Estimate process into clear, understandable steps. She’ll cut through the No Surprises Act legal jargon of supplying an accurate Good Faith Estimate and help you avoid errors that lead to lost revenue, audits, and sky-high monetary penalties.

Here are just a few of the questions you’ll get answered during this upcoming 60-minute online training that will help you comply with the complexities of providing an accurate Good Faith Estimate to your uninsured (self-pay) patients:

  • How should you respond to a patient dispute resolution based on your estimate?
  • What charges should be included and excluded on an estimate?
  • How far in advance of a procedure must you provide a Good Faith Estimate?
  • What disclaimers must be included on each Good Faith Estimate to comply with the law?
  • Does the type of service you provide dictate the format of your estimate?
  • Are you ever required to provide estimates to Medicare/Medicaid patients?
  • If a patient has insurance but chooses to self-pay, are you required to provide a Good Faith Estimate?
  • What format must your Good Faith Estimate be in: hard copy or electronic?
  • Are you required to include possible financial assistance options on your estimates?
  • How long are you required to keep the estimate if the patient chooses not to be treated?
  • Is an accurate Good Faith Estimate required if the patient has no financial responsibility?
  • Should your estimate include services from all providers that may treat the patient?
  • How can you provide an accurate Good Faith Estimate without a diagnosis?
  • If your practice posts its prices, are you still required to provide a Good Faith Estimate?
  • What if your initial Good Faith Estimate needs to be changed?
  • How detailed must your Good Faith Estimate be (i.e., supplies, etc.)?
  • Does providing your estimate over your patient portal comply with requirements?
  • Are there specific patient questions to help you comply (i.e., do you have internet access)?
  • Are you required to provide your Good Faith Estimate to HHS as well as the patient?
  • And so much more!

The administrative burden to your practice to provide your uninsured (self-pay) patients with accurate Good Faith Estimates is significant. You must master the nuances of this complex regulation to keep your practice’s billing and collection strategies compliant. This is the only way you will avoid the massive civil penalties of up to $10,000 for each violation.

Don’t risk making a mistake when it comes to providing an accurate Good Faith Estimate for your self-pay patients. You are required to adhere to the new No Surprises Act regulations effective January 1st. Don’t risk running afoul of the law.

Meet Your Expert

Gina L. Campanella
Esq, FACHEAttorney

Ms. Campanella is the founding attorney of Campanella Law Office where she focuses her practice on business law, healthcare regulatory and transactional matters, and residential and commercial real estate.  Campanella Law Office is a full-service boutique firm located in Wyckoff, New Jersey (with a satellite office in Pearl River, NY) and offering services federally and in New Jersey, New York, Vermont and Pennsylvania. Ms. Campanella is a nationally respected regulatory compliance specialist who dedicates herself to educating professionals nationwide on issues of business transactions and regulatory compliance.

Ms. Campanella graduated Magna Cum Laude from Seton Hall University with a Masters in Healthcare Administration in 2012 and earned her Juris Doctor from Seton Hall Law in 2005.  In 2002, she graduated with Honors from Union College with a Bachelor of Arts in History.

Ms. Campanella was recognized by New Jersey Super LawyersTM as a Rising Star in 2014,-2015 & 2017-2020, and as a Super Lawyer in 2022, a “Best of Bergen” attorney by Bergen Magazine in 2017-2019, and is recognized by AVVO as a Clients’ Choice Attorney in 2016-2022 with an AVVO rating of “10 out of 10”.*  Her additional certifications include earning the status of Certified HIPAA Administrator from the HIPAA Academy and she is a Fellow in the American College of Healthcare Executives.  Ms. Campanella is also an Adjunct Professor at the Seton Hall University School of Health and Medical Sciences.

Reviews

The webinar was well presented, clear and concise. No grey areas.
Phyllis Davenport
Administrator, Peripheral Vascular Associates
We found the webinar to be very helpful and provided very good information.
Magdalena Garcia
Executive Assistant to President & CEO, Seminole Hospital District