HHS Advisor Seeking Physician’s Opinion on NSA’s Good Faith Estimate Requirements

May 17, 2022
Hobbies: Advocacy

The Working Group for Electronic Data Interchange (WEDI), an official adviser to the U.S. Department of Health and Human Services (HHS), developed a short survey to assess how well the good faith estimate mandate (GFE) required under the law without surprises is difficult. (NSA) will be for the vendor community. We encourage you to have your say by completing the survey by Friday, May 20.

Effective January 1, 2022, the NSA includes an element of provider transparency for patients considering or planning care. NSA requires providers, including physicians and facilities, to inform patients of their right to receive a good faith estimate and provide a GFE of the expected charges for the services to be provided. At present, GFEs must only be provided to uninsured/self-paid patients – although providers may be required to generate them for patients with health insurance as well. (A self-paid patient refers to someone who has coverage, but chooses not to use its benefits.)

Providers and facilities are required to verbally and in writing inform uninsured/paying patients of their right to GFE. The notice must be prominently posted on the provider’s/facility’s website and in the provider’s office and facility.

In addition to notification, all providers and facilities are also required to provide GFEs to uninsured/paying patients who schedule items or services or request a quote. The GFE should be provided on request or at the time of scheduling, and it should include all services that should be provided to the patient, including by all co-providers, at the initial visit. The provider is required to provide the GFE directly to the uninsured/paying patient. Regulators will exercise their enforcement discretion in requiring GFE for uninsured/self-paid patients until rulemaking to implement this requirement is adopted and enforceable.

The WEDI NSA Task Force is very concerned about the actual application of these requirements and intends to build on the results of the investigation in a letter to the Secretary of HHS. To provide feedback on the GFE requirements, please respond to WEDI’s survey by Friday, May 20.

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