October 14, 2022
8 minute read
Workflow Automation

Good Faith Estimate Software for No Surprises Act Compliance

Rex H.
Rex H.
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Table of Contents
Table of Contents

 Since January 1, 2022, the No Surprises Act has required healthcare providers and insurance companies to issue good faith estimates (GFEs) to uninsured and self-paying patients. GFEs are documents outlining the estimated costs of patients' expected healthcare items or services. They ensure that consumers won't be caught off-guard by unexpected medical expenses.

However, creating, managing, and sending good faith estimates is easier said than done. The No Surprises Act has many requirements for what a good faith estimate should contain. For one, it should include primary items and services as well as services and items reasonably expected to be provided. You must also include several disclaimers and notifications. Additionally, there are several time frames for providing GFEs to uninsured and self-paying patients.

Fortunately, there's a quick and reliable way to generate, send, and manage GFEs — through GFE software. Read on to learn more about good faith estimate tools, what they are, and how they can help you comply with the No Surprises Act. We'll also show you how GFE software can improve your revenue cycle.

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What Is Good Faith Estimate Software?

Good faith estimate software accelerates and streamlines the GFE compliance process. With the software’s workflow automation, you can easily generate, send, and manage GFEs.

Depending on which GFE software you choose, you may also be able to:

  • Auto-send good faith estimates via text, email, or letter
  • Let patients make payment plan elections and upfront deposits directly from their GFE
  • Predict out-of-pocket costs at a high level of accuracy

How Good Faith Estimate Software Helps You Comply with the No Surprises Act

GFE software can help you comply with the No Surprises Act in many ways by helping you:

Create Compliant GFEs

First, GFE software can help you create compliant GFEs containing all of the required information, disclaimers, and notifications. This includes:

  • Patient name and date of birth
  • Description of the main item or service
  • The scheduled date of the primary item or service
  • A detailed list of the following, grouped by provider and facility:
  • Items and services reasonably expected to be provided for the primary item or service, including supplies, medical tests, prescription drugs, encounters, facility fees, and medical equipment
  • Items and services reasonably expected to be provided along with the primary item or service for the care period
  • Items and services reasonably expected to be offered by co-providers and co-facilities
  • Expected changes, expected service codes, and applicable diagnosis codes associated with each listed item or service
  • Expected changes are the cash pay rates established by a provider or facility for an uninsured or self-paying individual.
  • Service codes describe an item or service using National Drug Codes (NDC), Healthcare Common Procedure Coding System (HCPCS), Diagnosis-Related Group (DRG), and Current Procedural Terminology (CPT) code sets.
  • Diagnosis codes describe a patient's disorder, injury, disease, or other health conditions using the International Classification of Diseases (ICD) code set.
  • State(s) and office or facility location(s) where the items or services will be provided
  • Name, National Provider Identifier, and Tax Identification Number of each provider or facility in the GFE
  • A list of items or services that may require separate scheduling and are expected to happen before or after the care period for the primary item or service. You must include a disclaimer directly before this that includes:
  • A notification that information like expected changes, diagnosis codes, service codes, and provider and facility identifiers don't need to be included for services and items in the list. You will provide this information in separate GFEs after the patient schedules or requests the listed services and items.
  • An explanation that separate GFEs will be sent to a self-paying or uninsured patient after requesting or scheduling the listed items or services
  • Instructions for how a self-paying or uninsured individual can obtain GFEs for such items or services
  • A disclaimer that tells the uninsured or self-paying individual that the information in the GFE is only an estimate and that actual services, charges, and items may differ
  • A disclaimer telling the uninsured or self-paying individual that there may be additional recommended items or services that they must schedule or request separately. The disclaimer must state that these additional items or services aren't reflected in the GFE.
  • A disclaimer that the GFE isn't a contract and does not require the uninsured or self-paying individual to get the items or services from any of the providers or facilities in the GFE
  • A disclaimer informing the self-paying or uninsured individual of their right to start the patient-provider dispute resolution (PPDR) process if the actual charges are more than $400 higher than the expected GFE charges

Streamline Eligibility Verification for Estimates

The No Surprises Act requires that uninsured and self-paying patients receive good faith estimates. GFE software can streamline the identification of patients who need these estimates so you don't miss anyone.

Automatically Send Good Faith Estimates in Digital and Physical Formats

Good faith estimate software can also automatically send GFEs in several ways, including text, email, and postal mail. This helps you comply with the No Surprises Act, which gives uninsured and self-paying patients the right to request GFEs on paper, electronically, or in another form, such as through the phone or orally.

The auto-send functionalities of good faith estimate tools also help you meet No Surprises Act's stringent time frames for providing GFEs to individuals. Under the No Surprises Act, you must give a self-paying or uninsured individual a GFE within one business day after receiving their GFE request or scheduling a primary item or service for them. You must also provide GFEs to self-paying or uninsured patients within the following time frames:

  • When a main item or service is scheduled at least three days before the item or service's furnishment, you must send the GFE no later than one business day after the scheduling date.
  • When a main item or service is scheduled at least 10 days before the item or service's furnishment, you must send the GFE no later than three days after the scheduling date.
  • When a self-paying or uninsured individual requests a GFE, you must provide the GFE no later than three business days after the request date.

Not All Good Faith Software is the Same — Moving Past Simple Averages and Napkin Calculations

As with all things, not all GFE software is the same. Free good faith estimate solutions, in particular, usually generate basic templates and use simple calculations like averages for procedures. They also gloss over the subtleties of medical billing. This can have many adverse consequences, including inaccurate estimates and billing discrepancies.

Inaccurate Estimates and Billing Discrepancies Can Be Costly Due to Disputes

Inaccurate estimates and billing discrepancies aren't just irritating to deal with — they can also be costly due to disputes.

Under the No Surprises Act, uninsured or self-paying patients can dispute charges if they are more than $400 above what was provided in their GFEs. Specifically, they can request a determination from the No Surprises Act's patient-provider dispute resolution (PPDR) process for the amount they should pay.

The PPDR process can apply to any item or service provided by a convening provider, facility, co-provider, or co-facility to an uninsured or self-paying patient when the total charges are $400 or more than the GFE amounts.

How Good Faith Estimate Solutions Improve Your Revenue Cycle

Besides helping you avoid inaccurate estimates and billing discrepancies, GFE solutions can also improve your revenue cycle. Specifically, leading-edge GFE software can give you and your patients confidence with upfront collection. It also provides point-of-service collection and precise estimates.

Accurate Good Faith Estimate Software Gives You and Your Patients Confidence with Upfront Collection

If you trust your GFEs, you will be more comfortable taking payment upfront. You know the final billing charges will be equivalent or very close to what's on the GFEs.

Similarly, patients — especially returning patients — are more comfortable paying upfront when they see thorough GFEs. That's because they're not surprised and know what to expect.

Enabling Point-of-Service Collection Alongside Precise Estimates Has Multiple Benefits

GFE software also enables point-of-service collection along with precise estimates. These features provide several benefits, and can:

Reduce Accounts Receivable Days

Precise estimates and point-of-service collection give patients the confidence to pay upfront. As a result, you can receive and process accounts receivable much faster.

Decrease Bad Debt

Point-of-service collection and precise GFE estimates encourage patients to pay upfront more often, leading to increased cash flow. This, in turn, decreases bad debt.

Increase Patient Loyalty in a World of Healthcare Consumerism

Finally, point-of-service collection and precise estimates increase patient loyalty in a world of healthcare consumerism. They show patients that you care about them and that you value revenue transparency and flexible payment methods.

Cost of Good Faith Estimate Automation Software

Good faith estimate software typically has a variable pricing structure that is most heavily influenced by overall patient volume. The more patients an organization sees, the higher their costs will be. Smaller practices will pay less than larger practices - this allows the software to scale up or down in cost to meet a practice's needs.

Many solutions have other features and good faith estimate automation can be part of a suite or tools or as a standalone product - this too will affect the cost of the service depending on the features your practice needs.

In any case, integrating a good faith estimate software solution is a sound investment given the benefits it provides to your revenue cycle and upcoming enforcement of the No Surprises Act that features fines of up to $10,000 per violation.

Automate Good Faith Estimates and Collect Upfront with MD Clarity

Good faith estimate software offer many benefits, including the ability to create, manage, and send No Surprises Act-compliant GFEs to uninsured and self-paying customers. You can also use the platform to streamline eligibility verification for GFEs, automatically send GFEs in digital and physical formats, and improve your revenue cycle.

Intuitive, reliable, and streamlined, our Clarity Flow software can help organizations comply with the No Surprises Act and provide accurate GFE to patients. With Clarity Flow, healthcare providers can create, automate, and deliver estimates via mail, email, and text. They can also collect upfront deposits from patients from online estimates.

Book a demo today to experience the Clarity Flow difference.

Improve your financial performance while providing a more transparent patient experience

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