Under the No Surprises Act, providers are required to give a Good Faith Estimate (GFE) detailing the estimated costs of service for uninsured individuals. Providers are also required to give similar Good Faith Estimates for insured individuals who are unknowingly seeing out-of-network physicians. Ultimately, the actual costs billed may exceed the estimate, but charges far in excess of the estimate can be contested.
A Good Faith Estimate is made by a provider for an uninsured individual to outline the expected charges that will be billed to them. This estimate should be as complete as possible and include the cost of any items or services necessary or likely to be delivered along with the requested care, including those provided by another facility.
A GFE should be submitted to an individual when they request or schedule a service and doing so has been a requirement since January 1, 2022. Most facilities and providers will need to comply with GFE requirements.
The purpose of a Good Faith Estimate is to summarize the total amount that will likely be charged to a patient following the delivery of a requested service and the typical period of care associated with it. Therefore, a GFE should cover all associated costs in one document and be as complete as possible.
Some of the charges that may be compiled as part of a good faith estimate include medical services, tests, supplies, prescriptions, procedures, and any applicable fees.
In the event that an individual's bill substantially exceeds the good faith estimate that was provided to them, they are protected under the No Surprises Act and can use the patient-provider dispute resolution (PPDR) process to lower their out-of-pocket costs.
How TempDev Can Help You Implement a Good Faith Estimate Process
TempDev’s team of experienced consultants, developers, and trainers is here to support enhanced accessibility and customized features and templates. This enables you and your patients to have more control over data with improved transparency.
As part of our streamlining process, we help you implement the Patient Portal, API, and other tools to better support safety, patient engagement, and security. TempDev offers the comprehensive resources and tools you need to ensure compliance from dashboards to automation and workflow redesign.
Contact us here or by calling us at 888.TEMP.DEV to assist in streamlining your Good Faith Estimate process so that you are in compliance with the No Surprises Act.
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