CHAA No Surprises Act, Good Faith Estimates, and Price Transparency

Question 1

Under the No Surprises Act, who must receive a Good Faith Estimate (GFE) of expected charges?

Accepted Answer

Uninsured or self-pay patients who schedule a service or ask for an estimate

Answer

Providers must give GFEs to uninsured patients and to insured patients who choose not to bill their insurance, either when a service is scheduled or when the patient asks.

Question 2

A self-pay patient schedules a procedure 12 business days in advance. What is the deadline for giving the Good Faith Estimate?

Accepted Answer

Within 3 business days of scheduling

Answer

If a service is scheduled at least 10 business days ahead, the GFE is due within 3 business days of scheduling. If it is scheduled 3–9 business days ahead, the GFE is due within 1 business day.

Question 3

A self-pay patient can start the patient-provider dispute resolution process if the final bill is higher than the Good Faith Estimate by at least how much?

Accepted Answer

$400

Answer

Patients can dispute a bill that is $400 or more above the GFE for any provider or facility. They must start the dispute within 120 days of receiving the bill.

Question 4

Which situation is protected from surprise balance billing under the No Surprises Act?

Accepted Answer

Emergency services from an out-of-network hospital

Answer

The Act protects against balance billing for emergency services, certain non-emergency services from out-of-network providers at in-network facilities, and air ambulance. Ground ambulance is not covered.

Question 5

The CMS Hospital Price Transparency rule requires hospitals to post a consumer-friendly list or price estimator tool covering how many shoppable services?

Accepted Answer

300

Answer

Hospitals must show 300 shoppable services: 70 specified by CMS and 230 chosen by the hospital. They must also post a machine-readable file of all standard charges.

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Practice Test

CHAA No Surprises Act, Good Faith Estimates, and Price Transparency