What are the content requirements of a good faith estimate (GFE)? 

Providers and facilities are required to give good faith estimate to an uninsured (or self-pay) individual. Here we list down the top 10 content requirements of good faith estimate for healthcare issued to an uninsured (or self-pay) individual.
content requirements of a good faith estimate (GFE)

The content requirements of good faith estimate (or GFE) is a notification that outlines an uninsured (or self-pay) individual’s expected charges for a scheduled or requested item or service. Providers and facilities must give this estimate to an uninsured (or self-pay) individual (or their authorized representative) who requests it or who schedules an item or service. The good faith estimate will also include items or services reasonably expected to be provided along with the primary item(s) or service(s), even if the individual will receive the items and services from another provider or another facility.

These requirements are applicable for good faith estimates requested on or after January 1, 2022, or for good faith estimates required to be provided in connection with items or services scheduled on or after January 1, 2022.

Top 10 Content Requirements of Good Faith Estimate Includes :

A good faith estimate issued to an uninsured (or self-pay) individual must include:

  • Patient name and date of birth.
  • Description of the primary item or service in clear and understandable language (and if applicable, the date the primary item or service is scheduled).
  • Itemized list of items or services, grouped by each provider or facility, reasonably expected to be furnished for the primary item or service, and items or services reasonably expected to be furnished in conjunction with the primary item or service, for that period of care including both:
    • Items or services reasonably expected to be furnished by the convening provider or convening facility for the period of care.
    • Items or services reasonably expected to be furnished by co-providers or co-facilities.
  • Applicable diagnosis codes, expected service codes, and expected charges associated with each listed item or service for content requirements of Good faith Estimate.
  • Name, National Provider Identifier, and Tax Identification Number of each provider or facility represented in the good faith estimate, and the state(s) and office or facility location(s) where the items or services are expected to be furnished by such provider or facility.
  • List of items or services that the convening provider or convening facility anticipates will require separate scheduling and that are expected to occur before or following the expected period of care for the primary item or service. The good faith estimate must include a disclaimer directly above this list that includes all the following information:
    • Separate good faith estimates will be issued to an uninsured (or self-pay) individual upon scheduling or upon request of the listed items or services.
    • Notification that for items or services included in this list, information such as diagnosis codes, service codes, expected charges and provider or facility identifiers, do not need to be included as that information will be provided in separate good faith estimates upon scheduling or upon request of such items or services.
    • Instructions for how an uninsured (or self-pay) individual can obtain for content requirements of good faith estimates for such items or services.
  • A disclaimer that informs the uninsured (or self-pay) individual that there may be additional items or services the convening provider or convening facility recommends as part of the course of care that must be scheduled or requested separately and are not reflected in the good faith estimate.
  • A disclaimer that informs the uninsured (or self-pay) individual that the information provided in the good faith estimate is only an estimate regarding items or services reasonably expected to be furnished at the time the good faith estimate is issued to the uninsured (or self-pay) individual and that actual items, services, or charges may differ from the good faith estimate.
  • A disclaimer that informs the uninsured (or self-pay) individual of that individual’s right to initiate the PPDR process if the actual billed charges are substantially in excess of the expected charges included in the content requirements of good faith estimate. This disclaimer must include instructions for where the individual can find information about how to initiate the PPDR process and state that the initiation of the PPDR process will not adversely affect the quality of health care services furnished to the individual by a provider or facility.
  • A disclaimer that 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 content requirements of good faith estimate (example disclaimer notice can be found here).

These are the several content requirements of Good Faith Estimate to check. You can also get more details fabout content requirements of Good Faith Estimates from EMPClaims.

Example: This is how itemized lists of expected items or services could be displayed in the good faith estimate along with a disclaimer and instructions about the good faith estimate.

itemized-lists

Source: HHS PPDR Providers Guidance (cms.gov)

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