New: No Good Faith Estimates Required for Medicare Patients

Updated news: Providers are not required to provide GFEs to Medicare patients for non-covered services.

The original rule language indicated that Medicare patients would be entitled to Good Faith Estimates (GFEs) for Medicare non-covered services (i.e., examinations, modalities, physical therapy). However, last week, in response to an inquiry, a CMS enforcement official stated that federal health care program beneficiaries are not entitled to GFEs.

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Although the regulations state that even if patients have insurance, they would be entitled to Good Faith Estimates for items or services for which they do not have benefits, the CMS clarification provides relief to chiropractic physicians seeing Medicare patients. You are no longer required to provide GFEs to Medicare patients for non-covered services, i.e., all non-spinal adjustment services.

The new information comes directly from a representative of the CMS Center for Consumer Information and Insurance Oversight’s Provider Enforcement Team and states, “Under the No Surprises Act statute, providers and facilities are generally not required to provide GFEs 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 facility providing the GFE.”

In these cases, CMS believes that Federal health care program enrollees should “contact their applicable Federal health care program for information and program requirements related to enrollee notifications, protections, appeal rights, and appeals processes.”

For more information regarding Good Faith Estimate requirements, see the full article here.