Do Medicare Patients Get GFEs?
CMS has responded to an inquiry about what happens with Medicare maintenance patients and Good Faith Estimates (GFEs). Watch the video to learn more!
Transcription:
We’ve been providing our doctor’s information surrounding the no surprises act and good faith estimates and your responsibilities and requirements in your practice for providing your cash-paying patients or those patients that are paying cash even for items services, even if they have health insurance, how to and when you have to provide them good faith estimates. If you haven’t seen that information, check out the various videos that we have, check out the article that we have that’s extensive that walks all through this. But the other way you can find out more is to jump out and register for this year’s conference. The Fall convention, we are doing a two hour, a two-hour lecture, a two-hour course on Good Faith Estimate, you don’t want to miss that. Whether it be live in person or live virtual, or even the virtual portion of that will be available through the end of October. But there’s an important update that we want you to be aware of. And that is a shift with Medicare.
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When all of this was launched early in the year, you know, the ICS and a few other doctors and key stakeholders in the profession throughout the nation have begun to ask several questions to get clarification. And although it’s abundantly clear inside of the rules that were released, that you have to provide good faith estimates for those who are paying cash for services that aren’t covered by their insurance carrier. Right. So for items or services that are not covered in you know, they’re not covered, you do have to provide a good faith estimate, which would seem to be that you would provide those for maintenance care under Medicare. However, that is not the case. Actually, they just responded a handful of weeks ago and they indicated to the chiropractic profession very clearly that you do not have to provide good faith estimates to your Medicare patients. And for that matter for any federally funded program patient. Here’s exactly what they said inside of the response to the question that was posed. They said under the no surprises act statute providers and facilities are generally not required to provide good faith estimates to individuals insured under Medicare, Medicaid, or other federal health care programs. To clarify this policy applies even in cases where an individual’s federal health care program does not cover the items or services the individual is scheduling or requesting to be furnished by the provider or the facility providing the GFE.
So in other words for Medicare patients for medic care and Medicaid patients and other federally funded programs, you do not have to provide that patient a good faith estimate they’re actually expected to know and inside the email, they indicated that they should contact either the carrier or Medicare directly if they have further questions, they should know what is covered and what is not and what their responsibility is in those particular cases. So you could direct your patients in those particular instances, the 1-800-Medicare, that might be the easiest way to get them the assistance that they need. So this is an important shift we wanted you to be aware also, don’t forget the upcoming convention get registered today and I look forward to seeing you there. Take care.
