May 17, 2022
Area(s) of Interest: Advocacy Out of Network Billing
The Workgroup for Electronic Data Interchange (WEDI), an official advisor to the U.S. Department of Health and Human Services (HHS), has put together a short survey to gauge how challenging the good faith estimate (GFE) mandate required under the No Surprises Act (NSA) will be for the provider community. We encourage you to provide input by completing the survey by Friday, May 20.
Effective January 1, 2022, the NSA includes a provider transparency component for patients considering or scheduling care. The NSA requires providers, including physicians and facilities, to notify patients of their right to receive a good faith estimate and to provide a GFE of the expected charges for the services to be provided. Presently, GFEs must be provided to uninsured/self-pay patients only – although providers will eventually be required to generate them for patients with health insurance as well. (A self-pay patient means an individual who has coverage, but chooses not to use their benefits.)
Providers and facilities are required to notify uninsured/self-pay patients orally and in writing of the right to a GFE. The notice must be prominently displayed on the provider’s/facility’s website and in the provider office and facility.
In addition to the notification, all providers and facilities are also required to provide GFEs to uninsured/self-pay patients who schedule items or services or request an estimate. The GFE must be provided upon request or at the time of scheduling, and it must include all services expected to be provided to the patient, including by all co-providers, in the initial visit. The provider is required to furnish the GFE directly to the uninsured/self-pay patient. Regulators will exercise enforcement discretion on requiring the GFE to uninsured/self-pay patients until rulemaking to implement this requirement is adopted and applicable.
The WEDI NSA Task Group has significant concerns about the real-world application of these requirements and intends to leverage the results of the survey in a letter to the HHS Secretary. To provide feedback on the GFE requirements, please complete WEDI’s survey by Friday, May 20.