Voglio sapere a riguardo di…

lotter on DSK11XQN23PROD with RULES2

Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations unless such provider or employee is a family member of the uninsured or selfpay individual.
ii Convening health care provider or convening health care facility convening provider or convening facility means the provider or facility who receives the initial request for a good faith estimate from an uninsured or self-pay individual and who is or, in the case of a request, would be responsible for scheduling the primary item or service.
iii Co-health care provider or cohealth care facility co-provider or cofacility means a provider or facility other than a convening provider or a convening facility that furnishes items or services that are customarily provided in conjunction with a primary item or service.
iv Diagnosis code means the code that describes an individuals disease, disorder, injury, or other related health conditions using the International Classification of Diseases ICD code set.
v Expected charge means, for an item or service, the cash pay rate or rate established by a provider or facility for an uninsured or self-pay individual, reflecting any discounts for such individuals, where the good faith estimate is being provided to an uninsured or self-pay individual; or the amount the provider or facility would expect to charge if the provider or facility intended to bill a plan or issuer directly for such item or service when the good faith estimate is being furnished to a plan or issuer.
vi Good faith estimate means a notification of expected charges for a scheduled or requested item or service, including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service, provided by a convening provider, convening facility, co-provider, or co-facility.
vii Health care facility facility means an institution such as a hospital or hospital outpatient department, critical access hospital, ambulatory surgical center, rural health center, federally qualified health center, laboratory, or imaging center in any State in which State or applicable local law provides for the licensing of such an institution, that is licensed as such an institution pursuant to such law or is approved by the agency of such State or locality responsible for licensing such institution as meeting the standards established for such licensing.
viii Health care provider provider means a physician or other health care provider who is acting within the scope of practice of that providers license or certification under applicable State law,
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including a provider of air ambulance services.
ix Items or services has the meaning given in 45 CFR 147.210a2.
x Period of care means the day or multiple days during which the good faith estimate for a scheduled or requested item or service or set of scheduled or requested items or services are furnished or are anticipated to be furnished, regardless of whether the convening provider, convening facility, co-providers, or cofacilities are furnishing such items or services, including the period of time during which any facility equipment and devices, telemedicine services, imaging services, laboratory services, and preoperative and postoperative services that would not be scheduled separately by the individual, are furnished.
xi Primary item or service means the item or service to be furnished by the convening provider or convening facility that is the initial reason for the visit.
xii Service code means the code that identifies and describes an item or service using the Current Procedural Terminology CPT, Healthcare Common Procedure Coding System HCPCS, Diagnosis-Related Group DRG or National Drug Codes NDC
code sets.
xiii Uninsured or self-pay individual means:
A An individual who does not have benefits for an item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, Federal health care program as defined in section 1128Bf of the Social Security Act, or a health benefits plan under chapter 89
of title 5, United States Code; or B An individual who has benefits for such item or service under a group health plan, or individual or group health insurance coverage offered by a health insurance issuer, or a health benefits plan under chapter 89 of title 5, United States Code but who does not seek to have a claim for such item or service submitted to such plan or coverage.
b Requirements of providers and facilities1 Requirements for convening providers and convening facilities. A convening provider or convening facility must determine if an individual is an uninsured or self-pay individual by:
i Inquiring if an individual is enrolled in a group health plan, group or individual health insurance coverage offered by a health insurance issuer, Federal health care program as defined in section 1128Bf of the Social
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Security Act, or a health benefits plan under chapter 89 of title 5, United States Code;
ii Inquiring whether an individual who is enrolled in a group health plan, or group or individual health insurance coverage offered by a health insurance issuer or a health benefits plan under chapter 89 of title 5, United States Code is seeking to have a claim submitted for the primary item or service with such plan or coverage; and iii Informing all uninsured or selfpay individuals of the availability of a good faith estimate of expected charges upon scheduling an item or service or upon request; information regarding the availability of good faith estimates for uninsured or self-pay individuals must be:
A Written in a clear and understandable manner, prominently displayed and easily searchable from a public search engine on the convening providers or convening facilitys website, in the office, and on-site where scheduling or questions about the cost of items or services occur;
B Orally provided when scheduling an item or service or when questions about the cost of items or services occur;
and C Made available in accessible formats, and in the languages spoken by individuals considering or scheduling items or services with such convening provider or convening facility.
iv Convening providers and convening facilities shall consider any discussion or inquiry regarding the potential costs of items or services under consideration as a request for a good faith estimate;
v Upon the request for a good faith estimate from an uninsured or self-pay individual or upon scheduling a primary item or service to be furnished for such an individual, the convening provider or convening facility must contact, no later than 1 business day of such scheduling or such request, all coproviders and co-facilities who are reasonably expected to provide items or services in conjunction with and in support of the primary item or service and request that the co-providers or cofacilities submit good faith estimate information as specified in paragraphs b2 and c2 of this section to the convening provider or facility; the request must also include the date that good faith estimate information must be received by the convening provider or facility;
vi Provide a good faith estimate as specified in paragraph c1 of this section to uninsured or self-pay
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