US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149
Uninsured and self-pay individuals: good faith estimates and patient-provider dispute resolution (45 CFR 149.610 and 149.620; 42 U.S.C. 300gg-136 and 300gg-137) – US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149

US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149 149.610(b)(1)(i)-(iv): Ask every patient about coverage and whether a claim will be filed, treat any cost enquiry as a request, and advertise good faith estimates on the website, in the office and on site

What does 149.610(b)(1)(i)-(iv) require?

A convening provider or convening facility (the one that receives the initial request or schedules the primary item or service) must determine whether an individual is uninsured or self-pay by asking whether they are enrolled in a group health plan, individual or group coverage, a Federal health care program or an FEHB plan, and whether an enrolled individual is seeking to have a claim submitted for the primary item or service; must inform all uninsured or self-pay individuals that a good faith estimate is available on scheduling or on request, with that information written clearly, prominently displayed and searchable on the website, in the office and on site where scheduling or cost questions occur, given orally when scheduling or when cost questions arise, and available in accessible formats and in the languages spoken by the individuals; and must treat any discussion or enquiry about potential costs as a request for a good faith estimate.

Maintained by Gerard Blokdyk

Other controls in Uninsured and self-pay individuals: good faith estimates and patient-provider dispute resolution (45 CFR 149.610 and 149.620; 42 U.S.C. 300gg-136 and 300gg-137) – US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149

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The graph holds this control, the 0 it maps to, and the evidence behind each claim, over MCP and REST.