Compliance

No Surprises Act

Federal legislation protecting patients from unexpected medical bills for out-of-network services received at in-network facilities or in emergency situations.

In Detail

Effective January 2022, the No Surprises Act requires providers to give patients a Good Faith Estimate of expected charges before scheduled services. For PT practices, this means providing cost estimates including CPT codes, expected units, and patient responsibility. Violations can result in penalties up to $10,000 per occurrence. PRACTIS generates Good Faith Estimates automatically based on the plan of care and payer contract rates.

Related Search Terms

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Related Terms

Balance Billing

The practice of billing a patient for the difference between the provider's charge and the amount paid by insurance.

Explanation of Benefits (EOB)

EOB

A document from an insurance company explaining how a claim was processed, including what was paid, denied, and what the patient owes.

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