What Is A Good Faith Estimate & How Can Providers Be Prepared?
What Is A Good Faith Estimate?
The concept of a Good Faith Estimate (or GFE) was introduced alongside the No Surprises Act in early 2022. The estimate acts as notification of expected medical costs to those who are uninsured or choosing to pay for treatments separately from their medical insurance plan (self-pay patients).
The legislation must be followed by all licensed healthcare providers and there are no specified exemptions for certain specialities or types of facilities. The good faith estimate is not currently required for patients planning on using their insurance to cover service costs, but this may change in the future.
An uninsured or self-pay patient can expect to receive expected charges for a requested or scheduled service or procedure ahead of it happening, minimizing stress and reducing the number of post-treatment disputes.
The good faith estimate should cover all services that a provider would reasonably expect to perform as part of the treatment plan, including any secondary or essential services conducted by another facility or provider. The estimate can include both items and services for before, during and after the procedure, as well as immediate aftercare services.
What is the No Surprises Act?
It’s important to understand the wider Act that this estimate is considered to be part of and why these transparency measures are being introduced.
The No Surprises Act, legislation that became effective January 1st 2022, was put in place to protect patients from surprise medical bills after receiving (often) emergency care in a medical facility.
Much of the Act focuses on the pricing of essential out-of-network services like pathology, radiology and lab work that now must be priced according to in-network rates where there is no internal alternative. The No Surprises Act hopes to create transparency for patients with them being made aware of any additional costs for using out-of-network services so that they can make informed decisions on their treatment.
The Good Faith Estimate goes beyond the clarification of what is in-network and out-of-network offered by the No Surprises Act and provides uninsured individuals with an opportunity to receive high-quality medical care without falling into the trap of unknown costs, debts and long-term struggles as a result of medical treatment.
What Should Be Included in a Good Faith Estimate? (For Providers)
A Good Faith Estimate should be offered by providers in the healthcare industry to notify individuals who are uninsured (not enrolled in an insurance plan or covered by a Federal healthcare program) of expected costs for their medical treatments.
This is to help patients make informed decisions on the course of their treatment and to provide increased transparency in the healthcare industry. Insured patients who would like to pay for medical treatments outside of their pre-agreed plans may also ask for a good faith estimate to identify costs upfront to help determine their decision.
Creating a Good Faith Estimate
A Good Faith Estimate should generally be provided within three business days of a request. If it is within three business days of the Date of Service (DOS), the estimate must be provided within one business day. If the request is submitted within ten days of DOS, the estimate must be provided within three business days.
Here is a list of the details that should be included in the Good Faith Estimate:
Patient Details: The estimate should always include patient details, such as the patient’s full name and date of birth.
A clear, jargon-free description of the primary medical procedure or service: The good faith estimate should include a clear description of the procedure and the DOS. The language for this description should be simple and easily understood by non-specialists.
Items and services reasonably expected to be used with this procedure: The estimate should include an itemized list that clearly outlines any items or services that would be expected to support the primary procedure. Unexpected additional costs may occur due to complications or unforeseen circumstances. These do not need to be accounted for as they do not fall into the criteria of “reasonably expected”.
Detailed line items, expected charges, various medical codes and facility information will need to be clearly provided. Providers should also include disclaimer information so that patients are aware of the terms of the estimate. These should include things like:
- A GFE is an estimate and is therefore subject to change
- There may be additional items or services outside of those outlined in the GFE
- The Good Faith Estimate is not a contract
- There are rights to initiate dispute resolution between the patient and provider
If you are unsure, consult a legal professional to help you draw up the form with any necessary disclaimers.
The main challenge with creating these good faith estimates arises for medical IT teams. With so many options and potential for additional items and services, it seems clear that the most efficient way to manage GFEs is to find a way to automate them without losing the ability to be able to make changes to suit the patient where needed. Luckily, there are options for this.
Is a Good Faith Estimate Accurate?
A Good Faith Estimate is made based on which items and services can be reasonably expected as part of the service. This will include any essential care items but there may be unexpected additions if there are any complications or rare occurrences during the treatment. These additions can be fairly minimal, but if the patient’s GFE and final bill are different by a large margin, disputes between provider and patient are common.
How Can Companies Ensure Compliance?
The difficulty comes for businesses with internal regulation and consistency. It’s key that providers are classifying the same items as “reasonable expectations” while also allowing for cases to be examined on a personal basis.
For many providers, this leaves them with a software issue. Manually generating reports (particularly with a short turnaround time) can be a laborious task and cause problems for already busy professionals.
57% of IT leaders predict that manual processing costs are cut by up to 50% when automation is introduced into their day-to-day systems, alongside staff time savings of between 10 and 50% with the automation of previously manual tasks.
A good custom software development company will be able to help create and automate systems that are both reliable and offer flexibility where it is needed. They will ensure consistent and reliable records that benefit both the provider and the patient, while saving departments both time and money.
Creating a System That Works with a Partner You Can Trust
At i3solutions we have 25 years of experience helping businesses create systems that work for them. It’s absolutely crucial to internal operations that software is practical and relieves pressure from essential workers – and we strive to achieve that in every project.
Whether it’s the migration of systems, automation of processes, data collection and analytics, or completely custom-build software that you’re looking for, we have a solution to help you stay compliant, and continue to offer great services and treatments to your patients. Get in touch to discuss your options.
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