Good Faith Estimate

A written estimate of expected charges for scheduled healthcare services that providers must give to uninsured or self-pay patients under the No Surprises Act.

The Good Faith Estimate requirement came into effect with the No Surprises Act. If a patient is uninsured or self-pay, you must provide them with a written estimate of expected charges before providing scheduled services. The estimate must be provided within one to three business days of scheduling, depending on when the service is scheduled. The GFE must include: the patient's name and date of birth, a description of each item or service, the expected charges for each item or service, the provider or facility name and NPI, a diagnosis code if applicable, and information about the patient's right to dispute if the final bill exceeds the estimate by more than $400. This applies to all healthcare providers and facilities, not just hospitals. If you are a solo practitioner and an uninsured patient schedules an office visit, you need to provide a GFE. If you are performing a procedure that involves multiple providers (like a surgeon, anesthesiologist, and facility), each provider is responsible for their own portion of the estimate. The $400 threshold is important. If the actual bill exceeds your GFE by more than $400, the patient can initiate a patient-provider dispute resolution process. An independent arbiter reviews the estimate and the final bill and determines the appropriate charge. If the arbiter sides with the patient, you may need to reduce your bill. For credentialing, the GFE requirement adds another compliance obligation that payers may ask about. Some credentialing applications now include questions about your compliance with the No Surprises Act, including whether you provide GFEs. Create a template for your GFE and build it into your scheduling workflow. When an uninsured patient schedules, your front desk should automatically generate and provide the estimate. Most practice management systems now have GFE functionality built in. If yours does not, a simple template that you fill in with the patient's specific information works. The key is having a documented process so you do not miss the requirement.