No Surprises Act (2020) Editable Forms
The No Surprises Act is part of a legislative package passed in December 2020. Its primary goal is to ensure patients understand the costs of their healthcare services ahead of time, thereby reducing the likelihood of being surprised by a massive bill from their provider. While the law itself has been around for nearly a year, many of the rules implementing the law have only recently been finalized (and more are yet to come). This means that there are some actions providers need to begin taking before January 1, 2022 (the effective date for the existing rules), and providers will need to stay alert for additional changes that will be coming in the following year.
For a full explanation of the No Surprises Act and specific details of new guidelines and how they may affect your practice, please refer to the following Brookings Institute article.
Editable PDF Forms for the No Surprises Act
Download these editable pdfs of the Notice and Consent Form and Good Faith Estimate Form so that they can be sent to your patients and completed electronically. Once downloaded, you will need to personalize each one as needed per client. You may email these forms to your client(s) or use the attachments area of the client portal to share these documents.
NSA-2022-Good-Faith-Estimate-Template.pdfNSA-2022-Good-Faith-Estimate-Template-No-Instructions.pdf
CMS-10780-Appendix-IV---Standard-Notice-Consent-Updated.pdf
To learn more about the requirements of the No Surprises Act, the APA Services blog and CMS website have more information as well. Be sure to check the CMS website for new fact sheets and other resources going forward, as rules are continuing to be developed and announced.