ASCs must give cost estimates to patients: 7 details

ASCs and physician practices are required to provide cost estimates for expected charges to self-pay patients when scheduling procedures or services as part of the No Surprises Act, which went into effect Jan. 1.

There are other aspects of the law that don't apply to ASCs and physician practices, but the good faith estimate regulations do, according to a report from JDSupra, a legal analysis company.

Seven things to know:

1. Patients are considered "self-pay" if they are uninsured or decide not to submit the claim to their insurance provider. ASCs are required to ask all patients about their payment plans and then provide estimates to self-pay patients accordingly.

2. ASCs and physician practices must have a written notice of self-pay patients' right to a good faith estimate of anticipated charges. The facility is required to post the notice in the office, on its website and on-site where services are scheduled.

3. Any discussion or question about the cost of services the patient may undergo should be treated as a "good faith estimate" request.

4. The ASC must provide a written good faith estimate complying with federal regulations to self-pay patients upon request or when scheduling the primary service. The estimate must include the patient's name, primary service in clear language, an itemized list of services, diagnosis codes and anticipated additional services not reflected in the estimate.

5. The estimate must also provide a disclaimer that the actual charges may differ, and instructions on how the patient can dispute billed charges if they are at least $400 more than the initial estimate.

6. Good faith estimates must be provided within one day of scheduling a procedure if the procedure is scheduled at least three business days in advance. Facilities have three business days to provide good faith estimates if the procedure is scheduled at least 10 days in advance.

7. If ASCs or physician groups need to change the estimate, they must provide a change at least one day before services are rendered.

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