The No Surprises Act: What You Need to Know

Everything You Need to Know About the No Surprises Act

An unexpected windfall is likely at the top of the list of good surprises. But do you know what is not at the top of the list of good surprises? Medical bills.

What's no surprise, then, is that two-thirds of US adults worry about being able to afford these unanticipated medical bills. It's a problem that concerns so many patients that it now has the attention and action of both state and federal governments. To help solve this problem, Congress signed the No Surprises Act into law.

As its name suggests, the No Surprises Act establishes patient protection against most surprise medical bills from out-of-network, emergency service, and air ambulance providers. Two of the major provisions affecting providers - the good-faith estimate and balance billing requirements - became effective as of January 1, 2022.

The Good Faith Estimates (GFEs) or cost estimate provision likely concerns you the most, but don't worry. This is where PtEverywhere can help.

Good-Faith Estimates

The good-faith estimate is just what it sounds like. This provision requires providers to provide uninsured and self-pay patients with a good-faith estimate of the expected charges prior to providing services.

What must be included in the Good Faith Estimate?

The goal here is transparency. Estimates should be in writing and included in the patient's record. Once services are completed, if the actual cost exceeds the estimate by more than $400, the patient may dispute the medical bill.

How can PtEverywhere help you?

With PtEverywhere, our multi-functional physical therapy software means no bad surprises for you or for your clients.