No Surprises Act Resources

The No Surprises Act was enacted to protect clients from unexpected medical bills. While much of the No Surprises Act focuses on emergency services and out-of-network providers at in-network facilities, there are sections that apply to all healthcare providers. As a private mental health practitioner, the sections related to Good Faith Estimates and Balance Billing are most applicable.

A Good Faith Estimate is the charge you intend to levy on a client for your therapy services. It helps clients understand what they may be liable for if they seek care with you. Good Faith Estimates are not generally required for emergency services, which by their nature cannot be scheduled in advance.

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As of January 1, 2022, the U.S. Department of Health and Human Services (HHS) requires all practitioners to provide Good Faith Estimates for new and continuing clients who are either uninsured or not planning to use their insurance (i.e. pay out of pocket for their care). For clients who choose to use insurance coverage (in network or out of network) to pay for part of their care, you do not need to provide a Good Faith Estimate at this time, since HHS has deferred enforcement. We expect enforcement to begin after HHS releases implementation guidance (which could be days, weeks or months from now). Nirvana can help with providing Good Faith Estimates automatically for all clients, regardless of whether they are planning to use insurance. Our Peace of Mind Calculator provides these estimates in real time. If you are not currently a Nirvana customer, please reach out to our experts at sales@meetnirvana.com to learn more.

In order to comply with the new law, you will need to ask all current clients whether they have insurance and whether they intend to use their policy to cover your services. If the answer to either question is no, you should issue a Good Faith Estimate. To provide a Good Faith Estimate, we recommend you devise a standard charge sheet for the top codes at your practice. For example: 

• 45 minute therapy session (CPT 90834) - $200 
• 60 minute therapy session (CPT 90837) - $300

It’s important that all therapists in your practice quote from a standard charge sheet using this CMS-10780 form. These forms can be found in your EHRs, or downloaded separately using the above link. Nirvana can provide comprehensive analytics to help set up your charge sheet in compliance with the No Surprises Act. Please reach out to your Nirvana representative or help@meetnirvana.com for more information.

Therapists should provide a Good Faith Estimate to all new out-of-network clients moving forward. You will also need to retroactively provide Good Faith Estimates to all current out-of-network clients, to ensure that your practice is compliant with the law. A Good Faith Estimate is valid up to 12 months, or until client insurance status changes (whichever occurs first). Nirvana can automatically track the validity of Good Faith Estimates and provide new estimates as needed.

Your Good Faith Estimate should always reflect your full standard rate – even for clients who are eligible for sliding scale. While you may continue to invoice clients using a sliding scale rate, providing a Good Faith Estimate that reflects a reduced rate can expose you to legal challenges (i.e. a client may be able to appeal your bills). 

Nirvana can help you design your sliding scale process to comply with all federal, state, and insurance regulations. Please feel free to reach out to our experts at help@meetnirvana.com.

As per the No Surprises Act, all clients are protected from balance bills no matter which insurance they have (i.e. you cannot go after your client for any amount higher than copayment responsibility as per their plan benefit). Also, you cannot ask your clients to waive their rights to balance billing. Therefore, if you choose to accept reimbursements, reach out to your Nirvana representative to help establish billing processes that are compliant with this legislation.