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CMS Provides Update on Good Faith Estimate Requirements

Analysis  |  By Amanda Norris  
   February 28, 2022

In new guidance, CMS outlines how good faith estimates must be provided by the front-end revenue cycle.

CMS has recently published information concerning the good faith estimate provision of the No Surprises Act, which took effect January 1.

Healthcare organizations are now required to issue an estimate of the expected charges of a scheduled item or service to uninsured or self-pay individuals. This estimate prevents the patient from receiving surprise medical bills after the item or service is complete.

Looping in revenue cycle staff is essential since CMS further explains these requirements and how they can be implemented effectively in its latest guidance.

Some of the topics discussed include:

  • Definitions of the healthcare providers and facilities that must comply with the good faith estimate requirements, as well as the patients who must receive good faith estimates
  • How and in what forms good faith estimates must be provided and the administrative burden of doing so

Hospital leaders should review the good faith estimate requirements and CMS guidance to ensure they are acting in compliance with the No Surprises Act.

This is the latest guidance provided for organizations regarding good faith estimates and the No Surprises Act.

Previously, the American Hospital Association (AHA) published a No Surprises Act legislative advisory report that includes key takeaways about the law along with a 15-page detailed summary of the rule.

In addition, the legislative advisory webpage links to additional resources, including an FAQ for members about the uninsured/self-pay good faith estimate; details about the AHA/American Medical Association (AMA) lawsuit challenging how federal regulators proposed resolving billing disputes; and information about CMS guidance.

Other No Surprises Act resources for hospitals and health systems are available from the AMAHealthcare Financial Management Association, and the Medical Group Management Association.

 

Amanda Norris is the Revenue Cycle Editor for HealthLeaders.


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