Federal No Surprise Law Form - what needs to be in it?

Provided by:  Jennifer Kirschenbaum, Esq.

January 16, 2022

Question:

Hi Jennifer, 

I read last week's overview of the No Surprise Law but I'm still confused.  What do I have to post? 

Thank you, Dr. K

Answer:

Let's get to it!  You have to give the patients and also post a notice explaining - 

• what is a balance bill
• what a surprise bill is (non par provider stepping in and rendering services unbeknownst to patient in ASC or Article 28 setting, or airlift, etc.)
• restrictions on providers sending surprise balance bills
• applicable state law restrictions 
• information on contacting appropriate state and federal agencies in the case that an individual believes that a provider or facility has violated the restrictions against balance billing

CMS has a free sample here - https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf.  



We have compiled a Federal No Surprise Law form available by contacting Taryn at TCrimi@kirschenbaumesq.com.  We are charging a processing fee of $85.   The Federal No Surprise Law form does not represent our comprehensive NY Out of Network law forms.