CoFi Helps Ensure Compliance with the No Surprises Act

Under the No Surprises Act (NSA), patients are entitled to a good faith estimate (GFE) of charges from providers before scheduled services. If the actual charges by a particular provider or facility exceed the GFE amount by more than $400, the patient is entitled to dispute the charges under an arbitration process. (Source: AMA NSA Tool Kit)

Physicians’ responsibilities for the GFE differ depending on whether they serve as a “convening provider ” or a “co-healthcare provider.” A convening health care provider (or facility) is one that receives an initial request for a GFE or that is responsible for scheduling the primary service. A co-healthcare provider (or facility) is one that furnishes items or services in conjunction with the primary service.

Co-providers (and co-facilities) are required to provide the GFE information within one business day of a request from a convening provider or facility.

CoFi’s software contains preloaded fees from each party for each procedure: surgeon fees, facility fees, and co-managing OD. So the ophthalmology practice can furnish a comprehensive GFE that includes with each party’s fees, without having to request that information.

In premium IOL cataract surgery, for example, the patient can owe the Ophthalmologist (convening provider), ASC (co-facility) and even a co-managing OD (co-provider), separate amounts. Ensuring the patient is furnished with all of the required information elements is essential to compliance. 

Here are the required elements:

1. The patient’s name and date of birth
2. A description of the primary item or service in “clear and understandable language” and, if applicable, the date of scheduled service
3. The items or services expected to be provided in conjunction with primary service, grouped by provider or facility, with their diagnosis code, procedure code and expected charge
4. The name of and identifying information for each provider or facility
5. The items or services that require separate scheduling and that will be estimated in a separate GFE

CoFi’s unique multi-party invoice includes all of that information. 

The ophthalmology practice’s staff creates the invoice in about 30 seconds. Each party’s fees, with descriptions of services, name and address of each provider, and line items are all included — and customizable by the ophthalmology practice.