This article explains the Good Faith Estimate and breaks down new guidance from the Department of Health and Human Services. To learn more, see our blog post explaining the Good Faith Estimate.
The good faith estimate and the No Surprises Act
The Good Faith Estimate (GFE) is part of the No Surprises Act (NSA), which is federal legislation designed to protect patients from surprise medical bills that went into effect January 1, 2022. The Department of Health and Human Services (HHS) with other federal departments created the GFE to protect self-pay and uninsured patients from receiving bills that are substantially more than expected. This article explains the Good Faith Estimate and breaks down new guidance from the Department of Health and Human Services. To learn more, see our blog post explaining the Good Faith Estimate.
The GFE is an estimate of the cost to obtain healthcare without using any type of health plan. The legislation requires virtually all healthcare facilities and providers to 1) notify self-pay patients of their right to obtain a GFE of anticipated charges; and 2) provide a GFE of charges to the self-pay patient before items or services are rendered.
If the actual charges billed are $400 or more than the GFE, the self-pay patient may initiate what’s called the selected dispute resolution (SDR) process to determine what the patient must pay. For GFEs, the SDR process is also known as the patient-provider dispute resolution (PPDR) process.
New guidance from HHS
The following list is what HHS clarified regarding GFEs for self-pay/uninsured patients as published by Holland & Hart:
Rivet’s Estimates software offers accurate good faith estimates that you can send to patients via HIPAA-compliant text and/or email, or print out the estimate right in your office. Patients will see their deductible/out-of-pocket maximum met, diagnostic codes, their financial responsibility and their plan’s financial responsibility, prior authorization flags, customized disclaimers and more.
To see Rivet's Estimates and discuss billing pain points, request a demo below.