Does the No Surprises Act apply to my office?

Good faith estimates and the No Surprises Act apply to chiropractic practices, despite much misunderstanding and confusion. This week we provide answers to how they apply. Watch the video to learn more!

Link mentioned in today’s video:

Good Faith Estimates – No Surprises Act

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Transcript:

We hope you’re having a great day. There’s a lot of confusion surrounding good faith estimates in the No Surprises Act and whether or not it actually applies to chiropractic physicians. We just want to kind of clear that up and provide you with the information necessary for you to understand its applicability in your practice. So, the problem is, is when the No Surprises Act passed, as a part of the Consolidated Appropriations Act of 2021, passed in December of 2020. It passed it in its huge form. But there were actually two different primary portions of the No Surprises Act. So in July, when they first issued all of their rules, all of their rules really centered around Medicare Certified Facilities, air ambulances, and emergency situations, none of which affect really about 99.9% of our doctors, right, of chiropractic physicians. Those who practice in hospital settings, of course, it would impact them, but their employers a lot of times to take care of that compliance portion and what has to be done in that regard so they have someone to help them handle that.

The second part of the rules then issued at the end of September. And what was really strange about this particular set of rules is there were again, two primary portions that they dealt with, one was dealing more with what they had issued in July, and it’s surrounding those particular situations I just mentioned. The second part was much more broad, so we had a very limited definition of applicability in that first portion of the No Surprises Act, and we’re going to set that aside, not even talk about that, but just know that there are two primary portions. So if you see somebody say, it doesn’t apply, let me help you understand that it actually does apply to your practice, because it’s this next part, it’s a part that centers around providing good faith estimate to self-pay patients, that does apply to your practice. Here’s why, in the rules that were released in September, and they follow in the definitions, they just cleared up quite a bit more. But in the definitions, they really follow the federal law that actually passed back in December of 2020, for this particular portion. So this is a different rule set, and in this particular case, they broadened it. Here’s what it applies to, and here’s an exact quote, “These requirements are for health care providers and health care facilities.”

So instead of just health care facilities and air ambulances in emergency situations, it’s now health care providers and health care facilities. So when we talk about the good faith estimate requirement, we’re going to have a series of videos that explain a lot more about each of these pieces, but it does apply to healthcare providers and healthcare facilities. So it does apply to your practice. Now, if you’re wondering, okay, but what about the exact definition of health care provider? Here is the definition that they provide in the rules for this portion of that Act, and that is health care provider or provider means a physician or other health care provider who is acting within the scope of practice of that provider’s license, or certification under applicable state law, including other providers, so that doesn’t matter. But really the beginning of it does, right? Other health care providers or more specifically in Illinois, you are a physician, so means a physician or other health care provider. So it specifically includes chiropractic physicians, in this particular definition, because it calls you physicians, right? Or because we know that you are defined as physicians, and it references physicians here. So it absolutely does apply to chiropractic physicians, really chiropractic physicians across the United States, because it also lumps in even for states that don’t allow them to be called physicians, it does say other health care providers who are acting within the scope of practice of that providers license and so know that it does.

Now, here’s what I also tell you is it’s not just the ICS that is coming down in helping you understand the applicability in this particular section. But there have been a number of regulatory experts and many attorneys that side directly with us. In fact, the ACA has actually joined with their coalition and requested that HHS, exercise enforcement discretion for small practices, and we don’t know the outcome of that, but they have made that request so they understand the applicability to your practice as well. So understand, that good faith estimates absolutely apply. If you want the full suite of information and you want it today, which we would encourage you to take a look at. You can just visit ilchiro.org/gfe, so it’s io cairo.org org slash G F E. And that’s good faith estimate, by the way, and that will take you right into the article that gives you a full explanation of exactly what it is who it applies to. And when you have to provide it. We’ll cover some of this later. It’s not as broad as you may think it is, as far as who you have to provide these for. We’ll cover that next week. You take care.