Patient Disclosure Requirements

Providers and facilities are required to provide Patient Disclosures so that patients know their rights and protections included in the No Surprises Act. The Patient Disclosure must include information on:

• Federal restrictions on providers and facilities regarding balance billing
• Any applicable state law protections against balance billing
• Contact information for state and federal agencies should a patient believe that a provider or facility has violated prohibitions against balance billing

The Patient Disclosure requirements generally apply to ALL providers unless they do not provide services in conjunction with a facility.

The following details apply to the Patient Disclosure Requirements:

1. If your practice maintains a public website, that website must include the required disclosures. Note: Hospitals and Ambulatory Surgery Centers CANNOT fulfill this requirement for surgeons if the surgeon or practice has its own website.
2. Surgeons must place the disclosures on a "sign posted prominently in their office location," e.g. central location where patients schedule appointments, check-in, or make payment. Note: Surgeons can enter into written agreements with their practice facilities where the facility takes full responsibility for public signage.
3. Surgeons must provide a one-page disclosure to patients for whom patient protections included in the NSA could apply. Note: Surgeons can enter into written agreements with their practice facilities where the facility takes full responsibility for provision of the one-page disclosure document.

The following details apply to the One-Page Disclosure:

The following details apply to the One-Page Disclosure:

1. As required, surgeons must furnish a disclosure (meeting the criteria listed above) to patients with a group health plan, group or individual market health insurance coverage, and those with Federal Employee Benefits plans.
2. When required to furnish disclosure, it must be provided in accordance with the following timelines:
   • No later than the date and time on which the provider or facility requests payment from the individual.  Note: This includes request for co-payment.
   • If the provider makes no payment request of the patient, then the one-page disclosure must be provided to the patient no later than the date on which the provider or facility submits a claim for payment to the plan or insurer.
   • Disclosures may be shared with patients earlier, such as when appointments are scheduled or when other standard disclosures are provided.

A Model One-Page Disclosure form can be found here:

https://www.cms.gov/httpswwwcmsgovregulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-10780