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Professional Affairs Update- February 2022

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Professional Affairs Update- February 2022

Professional Affairs Corner

I have been working hard these past few weeks compiling information for you on the federal No Surprises Act which went into effect on 1/2/2022.  This article includes information I emailed to all OPA members, along with updates as of 2/4/2022. 

If you are on any professional listservs (e.g., American Psychological Association [APA], OPA), you have no doubt seen a bushel of opinions flying around about whether psychologists have to comply with this set of regulations at all, and, if so, which parts of the regulations must be followed.  I have been talking to the APA attorneys in Legal & State Advocacy for weeks as they have drilled into this set of regulations that were put out with a very short timeline before the regulations went into effect.  If you are on the OPA listserv, you have read my posts over the past month as different attorneys weighed in about compliance with the regulations.  APA attorneys also participated in sessions with the Centers for Medicaid & Medicare Services (CMS) and with staffers on Capitol Hill regarding the problems in the regulations. 

Here's my news for you today: On 2/4/22, APA released several new resources related to Good Faith Estimates. I decided to forward these resources as I know some of you are not members of APA and therefore do not receive their announcements. Many of you do not like and are distressed by the rules surrounding the Good Faith Estimates. APA is spearheading a variety of efforts to reduce and/or change the impact on psychologists, especially those of us in small private practices with little to no administrative support. In the meantime, however, it is advised that you show a good faith effort in sending estimates to clients who are impacted by the new rules. 

Here are links to the new APA resources.  These links are available to all psychologists, including those who are not members of APA.

Understanding the No Surprises Act: How to Provide estimates for your services (This resource provides a link to a template created by APA)
FAQs on the No Surprises Act and good faith estimates
Seven basic steps for starting your good faith estimate compliance 

APA is working in coalition with other professional groups (e.g., American Psychiatric Association, National Association of Social Workers) to provide feedback to CMS about the administrative burden on small or solo practices, as well as to clarify or even amend parts of the regulations.  You can read the letter sent to the US Department of Health & Human Services (HHS) Secretary Xavier Becerra here: Coalition letter to HHS about No Surprises Act

In short, here are some highlights of compliance with the No Surprises Act:

1)     Does your patient have insurance and do they intend to use it? 

a.     If the patient answers NO to either of those questions, YOU MUST PROVIDE A GOOD FAITH ESTIMATE OF THE COST OF TREATMENT
b.     If the cost of treatment exceeds the Good Faith Estimate by $400 or more, the dispute resolution provisions kick in for patients.
c.      At this point, if the patient is using insurance (whether billed directly by you or by the patient using a superbill), you do not need to supply a Good Faith Estimate.
d.     Whether you are billing out of network is not the issue.
e.      You should be asking this question BEFORE the patient is in your office, as the No Surprises Act has some tight timelines about providing a Good Faith Estimate.
f.      Be prepared that the rule making process for this act is continuing, and there will likely be additional parts with which we will need to comply for insured patients.
g.     If YOU have opted out of Medicare, the patient is considered self-pay, so Good Faith Estimate rules apply.

2)     What if I haven’t yet seen the patient (and have no diagnosis yet)?

a.     You can leave the diagnosis as TBD, but once you have a diagnosis, you will need to issue a revised Good Faith Estimate.
b.     You can estimate what a “typical patient” in your practice does (e.g., “most patients in my practice are seen for 12 sessions”).
c.      You might consider wording along the lines of “I won’t know the cost until we meet; this is the cost of the intake evaluation.” You should then do a second Good Faith Estimate after you have done your evaluation and diagnosis.

3)     Various templates for the Good Faith Estimate are floating around the internet.

a.     The CMS template (and the APA template adapted from that) do not require a patient signature.
b.     You should document in the patient chart that you provided the Good Faith Estimate in writing, and you should store a copy of the Estimate in the patient chart.  The patient should also get a copy.

4)     If you work in a facility, the compliance department for the hospital/facility should be giving you guidance about compliance (as the rules for facilities are different). 

As your Director of Professional Affairs, I continue to track this information, answer questions on the listserv, and work frequently with other Directors of Professional Affairs (DPAs), APA’s Legal & Regulatory Affairs, and APA’s Health Care Finance Group. 

With warmest wishes, 

Susan Rosenzweig, PsyD
OPA Director of Professional Affairs
drsusan@centerforpsychologyandhealth.com
503-206-8337

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