Blog | Patient Financial Communications

CMS makes templates available to help with aspects of the new surprise billing regulations

Blog | Patient Financial Communications

CMS makes templates available to help with aspects of the new surprise billing regulations

The U.S. Department of Health and Human Services projects that a business operations specialist could need an hour in some cases to generate a good-faith price estimate as will be required for uninsured patients.

CMS has published templates and resources that can guide healthcare providers in implementing some of the surprise billing requirements that take effect in January.

The resources, which are available for downloading, include forms for:

  • Notifying self-pay and uninsured patients of their right to receive a good-faith estimate of expected charges
  • Generating a good-faith estimate
  • Tracking the data elements that are required in the good-faith estimate
  • Tracking required documents for the provider-patient dispute resolution process, which can be used when charges exceed the good-faith estimate by at least $400

Estimates of the burden on providers

A separate file in the resource set provides HHS’s estimates of the cost and time burden that providers will incur in various aspects of the requirement to offer good-faith estimates to uninsured and self-pay patients.

For example, HHS projects that just shy of 3.5 million individuals per year will be entitled to receive such estimates. Almost 512,000 providers with healthcare facilities or physician practices will be obligated to furnish such estimates.

A provider organization’s business operations specialist would be expected to take either 30 or 60 minutes to generate each good-faith estimate, depending on whether items and services also are needed from a co-provider or co-facility.

CMS has stated that in 2022, it will exercise enforcement discretion in situations where the estimate leaves out charges from a co-provider. The relaxed enforcement recognizes the need for “additional implementation time to develop appropriate communication channels that may not yet exist among various co-providers or co-facilities.”

About the Author

Nick Hut

is a senior editor with HFMA, Westchester, Ill. (nhut@hfma.org).

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