No Surprises Act

[tinamprose]

In order to comply with the No Surprises Act, a good faith estimate (GFE) MUST be provided to every uninsured/self-pay individual at the time of scheduling or upon request and has to include:  Patient Name, DOB, Description of the Service, Expected Service Procedure Code, Expected Price, Diagnosis Code, Provider Name, Provider NPI, Provider TIN, Office location. 

It must also include: 1) a disclaimer that informs the individual that there may be additional items or services that the provider recommends as part of the course of care that are not reflected in the GFE.  2) A disclaimer that informs the individual that the information provided in the GF is only an estimate regarding items or services reasonable expected to be furnished at the time the GFE is ussed and that actual items, services or charges may differ from the estimate.  3) A disclaimer that informs the individual of their right to initiate dispute resolution if the billed charges are substantially in excess of the expected charges contained in the GFE. ) A disclaimer that the GFE is not a contract and does not require the individual to obtain the services from the provider/facility identified in the GFE.

SO.....We use "treatment plan" in WinOMS CS and have been printing the treatment summary.  This document satisfies some, but not all of the requirements.  I checked with support and the treatment summary doesn't seem to be a document that we can edit to supply more of the required information.  The treatment proposal CAN be edited but doesn't merge the codes, individual prices, etc. 

Other than creating a treatment plan and then creating separate merge letter, how can I get this done efficiently?  What are you all doing? 

[doran109]

Could either one of you send me a copy of the letters you have? I would love to model after them. My email is kbata@dceoms.com. I appreciate it.

[rich_omsafw]

We are using merged letters that have the info needed to cover ourselves on this.  I would be nice to edit the PTE/Summary to include the needed text for the No Surprise Act.