How the No Surprises Act Impacts Dentists - Laura Diamond

How the No Surprises Act Impacts Dentists - Laura Diamond

Have you heard of the federally implemented “No Surprises Act?” Were you aware that it applies to dentists? The No Surprises Act protects uninsured and self-pay patients from receiving surprise medical bills. So what does that mean for your practice? Find out in this episode of Talking with the Toothcop! 

Outline of This Episode

  • [1:23] The Federal No Surprises Act 
  • [3:35] What you have to do
  • [7:03] When did this become effective? 
  • [8:04] Why does any of this matter?
  • [9:52] Where this falls in order of operations
  • [11:00] Q&A session with Laura 
  • [17:49] How to connect with Laura
  • [19:46] Important compliance reminders

How the No Surprises Act applies to dentists

As of 1/1/2022, you need to provide patients an estimate of anticipated charges for dental services, i.e. “Good Faith Estimates” or GFEs. They must be provided upon request or upon scheduling an appointment—well in advance of the treatment plans and financial estimates you may be currently providing. 

Because you’re already providing financial estimates in advance of service, does that mean you’re exempt? NOPE. Sorry to tell you, that’s not the case. At this time, it applies to uninsured and self-pay patients. It may apply to insured patients in the future. 

What do you have to do?

Here are the basics: 

  • You have to provide notice to your patients of their right to receive a GFE
  • You must post a notice on your website
  • You must post a notice in your practice where scheduling and service costs may be discussed (so a check-in desk).

You need to implement a good faith form in your practice. You have to issue this to current and new uninsured and self-pay patients before you provide—or continue providing—services. This applies to anyone who even contacts your office. If they ask what you charge for a dental cleaning, you have to provide them with that estimate. 

What else do you need to know? 

  • Even if you provide a GFE verbally, it must also be provided in writing (mail, fax, or encrypted email). Before you give out this information verbally, it’s wise to tell a potential patient that you must follow up with this information in written form and ask for their name and address (and assure them this is federal law).
  • It must be provided within a specific time frame (1–3 business days after an appointment is scheduled or 3 days after an inquiry) 
  • GFEs must be mailed to current patients before you continue with treatment 
  • You have to maintain the estimates that you provide in a patient’s charting and document in their progress notes that you’ve talked about the GFE
  • They have to be maintained for six years (even GFEs for patients who never scheduled)
  • A GFE is the cost of services that you anticipate providing for a patient over a year. If those costs change, you must issue a new GFE. 

None of this is difficult. But it is just one more thing you have to implement. That’s why we’ve created a toolkit for you to help you implement this in your practice. 

Why does any of this matter?

If there is a difference of more than $400 between your GFE and billed charges, the patient can initiate a billing dispute that the HHS can investigate. Those decisions are reviewed by a third-party contractor. If the decision doesn’t go in your favor, you can lose out on legitimately earned fees. Secondly, this may become like HIPAA. A complaint may lead to your practice being audited and civil monitoring down the road. 

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