Healthcare practices that see uninsured or self-pay patients must meet specific requirements under the No Surprises Act, including providing Good Faith Estimates (GFEs) of expected charges. A strong GFE compliance process requires more than a pricing sheet. Your practice needs appropriate documents, patient notices, procedures, and systems to prepare and deliver estimates.
Jackson LLP drafts Good Faith Estimate policies and documents for healthcare practices and provides legal guidance on No Surprises Act compliance. We work with practices to create GFE processes that fit how they schedule patients, set fees, and collect payments.
Good Faith Estimate Requirements
The No Surprises Act generally requires healthcare practices to provide uninsured and self-pay patients with a Good Faith Estimate of expected charges. This applies when a patient schedules a service or requests an estimate. A patient who has insurance but chooses not to submit a claim for the service may be considered self-pay for purposes of these requirements.
GFEs are intended to give patients information about the expected cost of care before services are provided. The estimate should identify the anticipated healthcare items and services and their expected charges. Depending on the circumstances, the estimate may also need to account for services reasonably expected to be provided in connection with the primary service.
The timing requirements also matter. For example, when services are scheduled sufficiently far in advance, the practice must provide the estimate within specified business-day timeframes. Practices should also have a process for responding when patients ask questions about the cost of care or request an estimate.
A practice’s GFE obligations continue after the document is created. Staff need to know when an estimate is required, what information it should contain, how it should be delivered, and how updates or additional services should be handled.
GFE Policies and Document Drafting
A Good Faith Estimate policy should give your practice a consistent process for complying with the No Surprises Act. It can address how your practice identifies uninsured and self-pay patients, when estimates are prepared, who is responsible for preparing them, and how estimates are provided and maintained.
Jackson LLP can draft and review documents such as:
- Good Faith Estimate policies and procedures
- Good Faith Estimate forms
- Notices concerning a patient’s right to receive a Good Faith Estimate
- Patient-facing cost and payment documents
- Internal procedures for identifying uninsured and self-pay patients
- Documentation and record-retention procedures
- Policies addressing changes to anticipated services or charges
- Related No Surprises Act compliance materials
No Surprises Act Compliance for Independent Practices
Good Faith Estimates are one part of the broader No Surprises Act requirements. Independent practices should understand how the federal law applies to their patient population and billing practices, particularly when they routinely see patients who pay out of pocket or do not use insurance.
Out-of-network practices may also need to consider additional No Surprises Act requirements, depending on the services they provide and how they bill patients.
Our attorneys draft documents that address your practice’s specific procedures.
Patient-Provider Dispute Resolution
The No Surprises Act also creates a process through which certain uninsured or self-pay patients can dispute a bill that is substantially higher than their Good Faith Estimate. Generally, a patient may initiate the federal patient-provider dispute resolution process when the billed amount is at least $400 more than the estimate.
Practices should understand what documentation they may need if a patient disputes a bill. This can include the Good Faith Estimate, the bill provided to the patient, and supporting documentation explaining why the billed amount differs from the estimate. During the dispute process, federal requirements also restrict certain collection activity.
A well-designed GFE process can make it easier for your practice to maintain the records and documentation needed if a dispute arises.
Good Faith Estimate Legal Services
Jackson LLP works with physicians, therapists, nurse practitioners, and other healthcare professionals on the legal documents and policies needed to operate their practices.
Our Good Faith Estimate services may include:
- Drafting a customized GFE policy
- Preparing patient-facing GFE forms and notices
- Reviewing existing GFE documents for compliance
- Assessing No Surprises Act procedures
- Reviewing self-pay and cash-pay workflows
- Advising on GFE timing and delivery requirements
- Reviewing documentation and record-retention practices
- Advising on patient-provider payment disputes
- Updating existing documents when federal requirements change
Contact Jackson LLP to schedule a consultation about your practice’s GFE policies and documents.Â
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Frequently Asked QuestionsÂ
What is a Good Faith Estimate?
A Good Faith Estimate is a written estimate of expected charges for healthcare items and services provided to an uninsured or self-pay patient. The estimate is not a bill; it gives the patient information about expected costs before receiving care.
Who must receive a Good Faith Estimate?
The federal No Surprises Act generally requires healthcare providers and facilities to give GFEs to uninsured and self-pay patients who schedule services or request an estimate. This can include patients with insurance who choose not to submit a claim for the service.
When does a practice need to provide a Good Faith Estimate?
The timing depends on when services are scheduled. In general, patients scheduling care at least three business days in advance must receive a GFE, with the required delivery timeframe depending on how far in advance the service is scheduled. Patients can also request an estimate before scheduling care.
What should a Good Faith Estimate include?
A GFE should provide an itemized description of expected healthcare items and services and the expected charges. Depending on the circumstances, it may also need to account for services reasonably expected to be provided in connection with the scheduled service.
What happens if a patient is charged more than the Good Faith Estimate?
An uninsured or self-pay patient may be able to use the federal patient-provider dispute resolution process when the billed amount is at least $400 more than the Good Faith Estimate. Practices should maintain the estimate and supporting documentation in case a dispute occurs.
Can Jackson LLP draft a Good Faith Estimate policy and forms for my practice?
Yes. Jackson LLP can draft or review Good Faith Estimate policies, forms, notices, and related No Surprises Act documents based on your practice’s services, patient population, scheduling procedures, and payment model.
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