PYA Principal Martie Ross is quoted in the recently published Report on Medicare Compliance, in an article that covers some of the challenges healthcare organizations might face when working with multiple providers for good-faith cost estimates. In “Good-Faith Cost Estimates Have Twists and Turns; ‘The Definition of Self-Pay Is Inexact,’” Martie points out numerous questions providers may encounter if convening and co-providers don’t communicate when putting together good-faith cost estimates for uninsured or self-pay patients. Good-faith estimates are further complicated when determining what charges should be included for patients with high-deductible insurance plans or insurance plans that don’t cover certain procedures.
Figuring out whom providers must produce a good-faith estimate for also can be challenging. “That’s easy when the person doesn’t have insurance,” she said. “It gets tricky when the person has insurance, but you know at the time the request is made [that] insurance won’t cover it.” For example, many dermatology procedures are covered, and many aren’t, Ross said. If they’re not covered, hospitals and physicians may be unsure what costs to include in the estimate.
Read the full article on the Health Care Compliance Association’s (HCCA) COSMOS, an online platform for easy access to the latest compliance information.
Visit PYA’s website for an infographic providing further insight regarding when to present a good-faith cost estimate. For additional information on the No Surprises Act, visit our Healthcare Transparency page.
If you would like additional guidance with No Surprises Act compliance or any matter related to compliance, valuation, or strategy and integration, one of our executive contacts would be happy to assist. You may email them below, or call (800) 270-9629.