You may have heard the buzz surrounding the No Surprises Act. Signed into law as part of the Consolidated Appropriations Act of 2021, and officially taking effect on January 1, 2022, the new requirements are designed to protect consumers from unexpected healthcare bills.
As a dental provider, the No Surprises Act may not change anything about the way your private practice operates, but it’s important to be familiar with it to ensure you’re compliant. Here’s a quick look at how the new law works and potential ways it may affect your office.
The No Surprises Act is Designed to Prevent Excessive Balance Billing Arising from Emergency Treatment
If you’ve ever gone to the emergency room or taken a loved one, you probably know all too well how little control you have over your providers and the care you receive. Time is of the essence, and most people won’t stop to question whether the anesthesiologist or surgeon is in-network with their insurance company—especially if you’re visiting a facility that’s in-network. Unfortunately, these situations often result in surprise bills for the patient.
Historically, around 39 percent of people who visited the emergency room at an in-network hospital received an unexpected bill after per the Centers for Medicare and Medicaid Services (CMS), but by 2016, the number had risen to nearly 43 percent. Meanwhile, the average amount of a surprise bill jumped from $220 to $628.
While surprise bills are clearly a strain on patients and can easily cripple middle and low-income families, CMS notes that they’re often leveraged by providers to get higher in-network payments. So, they result in higher premiums and cost-sharing for consumers, plus increase costs for employers and the health care system in general too. The No Surprises Act is designed to help in all these situations.
Balance Billing Provisions Do Not Impact Most Dentists
Generally speaking, the balance billing aspects of the No Surprises Act only apply to:
- Emergency healthcare providers.
- Non-emergency providers who serve at out-of-network at in-network facilities.
- Out-of-network air ambulance service providers.
Because the laws are written to address healthcare insurance rather than dental insurance, most dentists will not be impacted by this particular provision per the American Dental Association (ADA).
Good Faith Estimate Provisions for Self-Pay Patients Will Impact Dentists
Another area the No Surprises Act addresses is good faith estimates for patients who are uninsured and those who do not have benefits available, also referred to as self-pay patients. According to CMS, the good faith estimate must:
- Be delivered in writing (paper or electronic) within three days of request or before treatment is scheduled.
- Include an itemized list of procedures along with procedure codes and expected charges, grouped by provider or facility.
These requirements are easily satisfied if your practice is using the Treatment Plan module in Practice-Web, which allows you to print paper copies of plans or email and text them to patients.
- Visit the Treatment Plans information page.
- Read about Treatment Plans in the User Guide.
- Watch Video Tutorial: Treatment Plan 1 – Treatment Plan Overview.
- Watch Video Tutorial: Treatment Plan 2 – Treatment Plan Estimates.
- Watch Video Tutorial: Treatment Plan 3 – Managing Treatment Plans.
Dispute Resolution Provisions May Impact Dentists
Self-pay patients also have the right to dispute a bill under the new guidelines. To qualify, the patient must report receiving a bill that’s “substantially in excess” of the estimate within 120 days of receipt. As of now, the threshold for “substantially in excess” is $400.
If a patient formally disputes an item or service, the provider will be sent a link to the federal dispute resolution portal and, per CMS, the provider will need to provide:
- A copy of the good faith estimate the patient received.
- A copy of the bill the patient received.
- Supporting documents that explain why the bill is higher than the estimate.
Once the dispute resolution process begins, providers cannot:
- Send the bill to collections and must pause collections if the process has already begun.
- Threaten to send the bill to collections or take any retaliatory action against the patient for disputing the charges.
- Collect late fees on unpaid amounts.
Provide Patients with Better Treatment Plans
Providing patients with detailed treatment plans is always good practice. It improves case acceptance, builds trust, and helps ensure your practice collects what’s earned in addition to keeping you compliant with the law.
With Practice-Web, you can create detailed treatment plans in minutes, have patients sign them digitally, print or digitally send them to the patient, and archive signed plans for easy retrieval later. If you’re already using Practice-Web and need help working with treatment plans, see the self-service resources linked in the article above or get in touch for one-on-one Support.
Not using Practice-Web yet? We’re happy to walk you through treatment plans, charting, billing, and all the ways Practice-Web can help your office thrive in a complimentary demo. Click here to connect with us and schedule one.