HFMA: Surprise Billing Regulations and How Providers Should Prepare

Nick HutDecember 20, 2021

Doctor speaking to a patient

  • Providers have had a mere three months to implement the processes needed to comply with a new requirement to furnish uninsured patients with good-faith price estimates ahead of services.
  • A key early step for any provider is to determine whether it generally will be the entity responsible for providing estimates, i.e., the convening provider.
  • Data management issues loom as a potential pitfall in efforts to fulfill the requirement.


Regulations to protect patients from surprise medical bills take effect Jan. 1, ushering in a slew of new procedures and requirements that providers are working to understand and implement. Probably the biggest source of anxiety is the obligation to provide good-faith estimates to self-pay and uninsured patients ahead of scheduled services.


The pertinent regulation was issued at the end of September, giving providers little time to understand their obligations and incorporate compliance protocols.


“As much as the federal agencies would like to say, ‘We'll [use] discretion here and not necessarily go to enforce this,’ if it's the states that are enforcing it, they have every right to assume that it is in effect and go after folks who don't get it done,” said Kathryn Beard, regulatory compliance manager with R1 RCM.


Read the full article here.

Author Bio: Nick Hut is a senior editor with HFMA, Westchester, Ill.