Understanding Good Faith Estimates

For patients who are paying out-of-pocket, health care providers are required to give an estimate of expected charges to the patient at the time of scheduling or when asked - this estimate is called a “Good Faith Estimate”

A Good Faith Estimate isn’t a bill - it's a list of expected charges for items or services that you plan to provide

Generally, the Good Faith Estimate should include expected charges for the primary service and any other items or services you'd reasonably expected to include as part of providing that service
For patients booking online for a discrete service with a published price point, a Good Faith Estimate is not needed

There are specific timeline requirements sent forth around Good Faith Estimates

For an item/service scheduled at least 3 business days before the date of the item/service, the provider must provide a good faith estimate no later than 1 business day after
For an item/service scheduled at least 10 business days before the date of the item/service OR if the patient asks for a GFE, the provider must provide a good faith estimate no later than 3 business days after

Pulled from the What's A Good Faith Estimate Factsheet for patients from the US government's Center for

Centers for Medicare & Medicaid Services: https://www.cms.gov/files/document/nosurpriseactfactsheet-whats-good-faith-estimate508c.pdf

Setting up your GFE Templates

Under Settings > Payments > Good Faith Estimates, you can create a Good Faith Estimate template

Here's some sample language you can use

Disclaimer

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time this estimate was created.

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, and your bill is $400 or more for any provider or facility than your Good Faith Estimate for that provider or facility, federal law allows you to dispute the bill.

The Good Faith Estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from any of the providers or facilities identified in the Good Faith Estimate. If you are billed for more than this Good Faith Estimate, you may have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. If you dispute your bill, the provider or facility cannot move the bill for the disputed item or service into collection or threaten to do so, or if the bill has already moved into collection, the provider or facility has to cease collection efforts. The provider or facility must also suspend the accrual of any late fees on unpaid bill amounts until after the dispute resolution process has concluded. The provider or facility cannot take or threaten to take any retributive action against you for disputing your bill.

There is a $25 fee to use the dispute process. If the Selected Dispute Resolution (SDR) entity reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate, reduced by the $25 fee. If the SDR entity disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to www.cms.gov/nosurprises/consumers or call 1- 800-985-3059.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800- 985-3059.

Generating and Sending Individual Good Faith Estimates

Then, create and generate a Good Faith Estimates for a patient (the equivalent of a mock superbill estimate)

Go to Shortcuts in the Navigation Bar > Admin > Good Faith Estimates

Add in the Practitioner, Location, and Select the Patient
Add the Products and Services you expect to use in treating the patient
If needed, add "Sales Tax" as a service (if sales tax will vary, then manually adjust the amount)
Pull in your Good Faith Estimate template from the step above, or add your own text
Click Save to generate a PDF you can download and email, or print, for the patient or save in documents to be viewed in the patient's portal

Understanding Good Faith Estimates

Setting up your GFE Templates

Generating and Sending Individual Good Faith Estimates

Related articles