Bass, Berry & Sims attorney Jeff Davis wrote an article for a magazine published by the American Medical Group Association (AMGA) on emerging enforcement actions under the No Surprises Act. Jeff outlined the requirements of the act and the risks of noncompliance and provided considerations for medical groups to improve compliance and be prepared for any enforcement activity.
The move in late 2023 to begin sending enforcement letters to medical groups marks a new phase in the federal government’s implementation of the No Surprises Act, Jeff wrote. The enforcement letters primarily fall into two categories: the ban on balance billing applicable to some providers for patients covered by private insurance, and the requirement for all providers to give a good-faith estimate (GFE) of expected charges to uninsured and self-pay patients.
Medical groups should review their current practices to compare those with the regulations on the ban on balance billing and the GFE requirements, Jeff wrote, adding specific considerations for each of these requirements including:
- For providers subject to the ban on balance billing, Jeff suggested reviewing their websites and workflows to ensure the necessary disclosures are being made and no balance bills are being sent to patients.
- Medical groups also should review policies, procedures and workflows regarding the GFE requirements, ensuring that they are asking patients about their insurance status and providing the necessary disclosures to uninsured and self-pay patients about their expected charges.
The full article, “Taken by No Surprise,” was published in the July/August edition of AMGA’s Group Practice Journal.