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The No Surprises Act and Good Faith Estimates

The No Surprises Act and Good Faith Estimates

The No Surprises Act, also known as No Surprise Billing, will take effect on January 1, 2022. This act is part of a legislative package that was passed in December 2020. This guide is a resource for answering your questions regarding this new legislation. In this guide, we’ll cover:


No Surprises Act overview

The No Surprises Act, which is part of the Consolidated Appropriations Act of 2021, is designed to protect clients from receiving unexpected medical bills. The Good Faith Estimate provision of the No Surprises Act is designed to give clients an estimate of how much they’ll be charged for the healthcare services they’ll be receiving, prior to their appointment. 


Requirements for providers

As of January 1, 2022, this new legislation applies to all healthcare providers and facilities operating under the scope of a state-issued license or certification. You’re required to share a specific consent document in addition to a Good Faith Billing Estimate, prior to beginning care. 

State-licensed or certified healthcare providers are required to provide a Good Faith Estimate of charges to every new and continuing client who’s either uninsured or isn’t planning to submit a claim to their insurance for the services they’re seeking. You’re also required to inform every uninsured or self-pay client of their right to receive a Good Faith Estimate.

We recommend asking each client whether they have insurance and intend to use it to cover the services that they seek. If the answer to either question is no, they’ll need a Good Faith Estimate prior to their appointment.


Sharing the consent document and Good Faith Estimate with clients

Note: You can find a PDF version of both the consent document and the Good Faith Estimate under Forms at the bottom of this guide.

We recently added a new assessment template titled: Good Faith Estimate for Health Care Items and Services to the Template Library. Follow the steps below to customize and share it with your clients.

To add this template to My Notes and Forms:

  • Navigate to Settings > Notes & Forms > Template Library
  • Under Assessments, click + Add next to Good Faith Estimate for Health Care Items and Services

add.simplepractice.goodfaithestimate.png

Note: See How to use the Template Library for additional details.

To customize this assessment with your provider and practice information:

  • Navigate to Settings > Notes & Forms > My Notes & Forms
  • Under Assessments, select Good Faith Estimate for Health Care Items and Services to edit
  • Click Save

To create a Good Faith Estimate for Health Care Items and Services for a specific client:

  • Navigate to the client’s Overview page
  • Click New > Assessment
  • Use the dropdown menu to select Good Faith Estimate for Health Care Items and Services

dropdown.simplepractice.goodfaithestimate.png

  • Fill out the assessment
  • Click Save
  • Review the assessment
  • Click Sign > Sign & Lock
  • Click the downward arrow in the top right corner to download it

download.simplepractice.goodfaithestimate.png

Note: See Adding assessments, diagnoses, and treatment plans for additional details.

To upload the newly created Good Faith Estimate for Health Care Items and Services for a specific client:

  • Navigate back to the client’s Overview page
  • Click Upload in the top right corner

upload.simplepractice.goodfaithestimate.png

  • Select the Good Faith Estimate for Health Care Items and Services that was downloaded for the client
  • Click Upload

Note: The assessment will be located in the Uploaded Files section in the right panel of the client’s Overview page. You can also follow these steps to upload the specific consent document. A PDF version of this consent document can be found under Forms.

To share the recently uploaded Good Faith Estimate for Health Care Items and Services with a specific client:

  • Navigate to the client’s Overview page
  • Click Share in the top right corner
  • Select the check box for Good Faith Estimate for Health Care Items and Services under Uploaded Files

checkbox.simplepractice.goodfaithestimate.png

  • Continue through by clicking the prompts in the bottom right corner
  • Click Share & Send Now to send the email

Note: See How do I share documents with existing clients? for additional details.

Tip: Our team is currently working on feature enhancements that will allow clients the ability to e-sign assessments, progress notes, and diagnosis and treatment plans via the Client Portal.


Additional resources


FAQs


Are client signatures required on the consent document or the Good Faith Estimate?

Both the consent document and the Good Faith Estimate aim to protect clients by educating them about the differences between in- and out-of-network coverage. A signature on either document consents to the following:

  • I’m giving up some consumer billing protections under federal law.
  • I may get a bill for the full charges for these items and services, or have to pay out-of-network cost-sharing under my health plan.
  • I fully and completely understand that some or all amounts I pay might not count toward my health plan’s deductible or out-of-pocket limit.

Client signatures aren’t required on either the consent document or the Good Faith Estimate, however, if the client chooses not to sign, the provider can opt out of providing care and the client can proceed to find an in-network provider instead.


Is there a way to be reminded of when it’s time to update a Good Faith Estimate or when the amount estimated has been reached?


When will the Product team be allowing signatures on documents?

  • Our team is currently working on feature enhancements that will allow clients the ability to e-sign assessments, progress notes, and diagnosis and treatment plans via the Client Portal.
  • In the meantime, we recommend commenting and/or voting on this feature enhancement below on our Ideas and Suggestions board. That way, you’re notified via email when it's released.

Will the Good Faith Estimate for Health Care Items and Services assessment template be made available for customers on the Essential plan?

  • Customers on the Essential plan don’t have access to Assessments. At this time, there are no plans to enable customers on the Essential plan to access the Good Faith Estimates For Health Care Items and Services assessment template. Instead, we recommend that our Essential plan customers download these documents from cms.gov or from the Forms section of this Help Center guide. These documents can still be uploaded to a client’s profile and shared with them via the Client Portal. To do this, please see: How do I upload and share documents for individual clients?

Why can't the Good Faith Estimate for Health Care Items and Services assessment template be auto-filled similarly to a superbill? Why do we have to fill out information manually for each client?

  • The No Surprises Act requires that state-licensed and certified healthcare providers provide a Good Faith Estimate of charges to every new and continuing client who’s either uninsured or isn’t planning to submit a claim to insurance for the services that they’re seeking. The Good Faith Estimate includes client-specific information that qualifies as PHI, such as the client’s name, date of birth, and contact information. SimplePractice doesn’t currently have the functionality to auto-fill this information into an assessment or any other document for each client.

Forms

You can find a PDF version of both the consent document and the Good Faith Estimate from cms.gov below:

Still have questions?

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