What IS a Good Faith Estimate?

Good faith estimates apply to your practice per the No Surprises Act. This week, we provide details of what is included in a good faith estimate for your patients. Watch the video to learn more!

Link referenced in this video:

Good Faith Estimates – No Surprises Act

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Transcript:

We’re talking this week again about good faith estimates and that portion of the No Surprises Act that absolutely applies to your practice. A couple of weeks ago, we shot the video and told you and explained why this good faith estimate portion does apply to you when other portions of the no surprises act don’t really apply to you. And then last week, we talked about who actually gets it. Now remember, it’s a small portion of your patient population, I strongly encourage you to check out those videos on our YouTube channel, and that way, you know exactly what’s happening there. It’s important to understand both of those factors as you look at this, but the bigger question is really, okay, so what is a good faith estimate? And so, what are the components? What does it have to be? Can I just tell them? Can I go over to them? Can I just put it in my own form? And the answer to a lot of these things is really no, because you know, whenever the government gets involved, know that, that they’re going to detail exactly how you have to comply, right?

So, first of all, the thing to understand is a good faith estimate in regards to the no surprises that is specific to the patient that is making the request for a good faith estimate. So knowing this it has to be specific to them, their condition, their treatment plan, and the services that you anticipate to render. And so there are specific elements that they have identified, that must be included on the good faith estimate. Let me give you a shortlist. Now, this is not everything. But these are some of the key components. Of course, because it’s specific to the patient, it’s got to include their name, and it has to have a list of all reasonably expected services for that scheduled visit the one that they’re actually scheduling at that time. And it has to include all of the prices, you have to include both the CPT codes, as well as the ICD 10 codes, both of those are going to be important and must be on there. Now, I’m going to pause real quick there because some of you are gone. But Marc, if this is a new patient, we don’t have an ICD 10 code, that’s fine. But you do include that as you would put a TBD, it’s to be determined because you have never seen that patient, and you can’t include an ICD 10 code in there. But in order to comply, you can add a TBD whatever you do, don’t have your staff guess at what that ICD 10 code is because they don’t know you haven’t even seen the patient that would be rendering a diagnosis. without ever even seeing the patient, that would be a serious potential challenge to the standard of care. And so you put TBD and what that does is it tells anybody who looks at that form that you did make a good faith effort on that good faith estimate to include all the pertinent information.

Now, once you have made that diagnosis, then anything further must have the ICD 10 code as it relates to the diagnosis code for that specific patient. Anyway, CPT codes and ICD 10 codes must be on the form. Patient-provider identifying information and include your NPI. You have to have the appointment date if they’ve scheduled it. Now, they can ask for a good faith estimate, even if they’re not scheduling an appointment that enables them to be able to look at a couple of different places that they may want to go and receive care from. And then there’s also several disclaimers that have to be included. And in those particular cases, you have to include those disclaimers on the good faith estimate.

Now what else, it does not have to be on a specific form. So you don’t have to use the governmental form or the one that they provide. It’s about nine pages long. And I’m not joking, you don’t have to use that one. There are other ways to consolidate and be a bit more efficient with your paperwork. In fact, if you visit ilchiro.org/gfeE, that’s ilchiro.org/gfe, you’ll see our full article on the good faith estimates. Go to the very bottom of that and you can see some downloads, one of those downloads is a template that you’re able to use. In your practice, you can modify it to fit and make sure if you’re removing an element, it’s not one of the required elements. Most of the items that are on that form right now are the required elements for the good faith estimate, so that’s it. Now, it also must always be in writing. In other words, what they indicated was, although you can provide an oral description in an oral good faith estimate, in order to satisfy the law, you must get it in writing. So it must be done.

Now when I say in writing want to make sure it’s clear, it’s not necessarily they’re handing them a piece of paper. But it has to be in a form if you provide it either through their patient portal or maybe through email. They have to have the ability to be able to download and print so they have to be able to save that form and print it. That is a requirement that they have placed inside of the No Surprises Act for the good faith estimate. So, although, again, you can give it orally but it must be in writing, and again, it can be done electronically as well. Now, those are the really the biggest things and the most important things to understand it when it comes down to the actual Good Faith Estimate and what it is, again If you haven’t checked out the previous videos, that’s going to be really important for you to have. And please don’t be deceived. This does apply to your practice and patients are experiencing this as they’re scheduling with other providers in your area. And so this is going to become more commonplace pretty much every single day as more and more medical appointments are scheduled by your patients and when they come and see you. So hopefully this helps you out. We’ll catch you next week.