The No Surprises and Surprise Billing Consumer Protections Acts-GHA No Surprises GFE 022522 w DSH additions

GHA No Surprises GFE 022522 w DSH additions

Pdf Summary

The document outlines the "No Surprises Act" and related actions and guidelines for healthcare providers in Georgia, presented by Kathy Reep, Keri Conley, and Donna Hatcher to the Georgia Hospital Association. It details both the federal No Surprises Act, effective January 1, 2022, and Georgia's Consumer Protection Act, effective January 1, 2021. The federal act aims primarily to eliminate surprise billing and establish new payment methodologies for out-of-network (OON) services while providing good faith estimates for self-pay patients.<br /><br />Georgia's Consumer Protection Act mainly applies to fully insured plans licensed in Georgia, excluding limited benefit plans, certain federal or self-insured plans, and others. It protects consumers from unexpected bills due to out-of-network emergency and non-emergency services provided at in-network facilities. Providers must accept in-network cost-sharing and cannot balance bill unless patients opt for OON services with consent.<br /><br />The federal No Surprises Act prohibits surprise billing for emergency and certain non-emergency services at in-network facilities, ensuring patients are charged only their in-network cost-sharing amount. It outlines emergency situations and specific non-emergency medical services that cannot result in higher out-of-pocket costs for patients, assuming patients haven't been given advance notice and consented to higher charges.<br /><br />Good Faith Estimates (GFE) are mandatory for self-pay patients, detailing total expected charges for services. This includes patients with no insurance, those who choose not to use insurance, or those with no coverage for certain services. The act requires clear notice about a patient's rights under the act and outlines billing dispute measures when the actual bill exceeds the estimated charges significantly.<br /><br />The document includes a step-by-step guide on ensuring compliance with the acts, including dispute resolution procedures and ensuring notice requirements are met. It emphasizes on open communication with patients and correct billing practices to avoid disputes under the No Surprises Act.

Keywords

No Surprises Act

Georgia Hospital Association

surprise billing

out-of-network services

Consumer Protection Act

good faith estimates

self-pay patients

emergency services

billing dispute

compliance guidelines