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The No Surprises Act and Good Faith Estimates

The No Surprises Act and Good Faith Estimates

Important: The information below is specific to using the No Surprises Act Good Faith Estimate & Consent Disclaimer for Health Care Goods and Services template within SimplePractice. It’s the responsibility of each respective provider to ensure their Good Faith Estimates & Consent Disclaimers are in compliance with local, state, and federal guidelines.

The No Surprises Act, also known as No Surprise Billing, will take effect on January 1, 2022. This act is part of a legislative package that was passed in December 2020. This guide is a resource for answering your questions regarding this new legislation. In this guide, we’ll cover:


No Surprises Act overview

The No Surprises Act, which is part of the Consolidated Appropriations Act of 2021, is designed to protect clients from receiving unexpected medical bills. The Good Faith Estimate provision of the No Surprises Act is designed to give clients an estimate of how much they’ll be charged for the healthcare services they’ll be receiving, prior to their appointment. 


Requirements for providers

As of January 1, 2022, this new legislation applies to all healthcare providers and facilities operating under the scope of a state-issued license or certification. You’re required to share a specific consent document in addition to a Good Faith Billing Estimate, prior to beginning care. 

State-licensed or certified healthcare providers are required to provide a Good Faith Estimate of charges to every new and continuing client who’s either uninsured or isn’t planning to submit a claim to their insurance for the services they’re seeking. You’re also required to inform every uninsured or self-pay client of their right to receive a Good Faith Estimate.

We recommend asking each client whether they have insurance and intend to use it to cover the services that they seek. If the answer to either question is no, they’ll need a Good Faith Estimate prior to their appointment.

Providers are also required to highlight the No Surprises Act on their Professional Website. A link to more information about the No Surprises Act must be present, along with a statement informing clients that they’re entitled to a Good Faith Estimate. To do this, see: Making sure your Professional Website is compliant.


Sharing the consent document and Good Faith Estimate with clients

Note: You can find a PDF version of both the consent document and the Good Faith Estimate under Forms at the bottom of this guide.

We recently added a new assessment template titled: Good Faith Estimate for Health Care Items and Services to the Template Library. Follow the steps below to customize and share it with your clients.

To add this template to My Notes and Forms:

  • Navigate to Settings > Notes & Forms > Template Library
  • Under Assessments, click + Add next to Good Faith Estimate for Health Care Items and Services

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Note: See How to use the Template Library for additional details.

To customize this assessment with your provider and practice information:

  • Navigate to Settings > Notes & Forms > My Notes & Forms
  • Under Assessments, select Good Faith Estimate for Health Care Items and Services to edit
  • Click on the form title and scroll to Provide Estimate to update the provider information section
  • After making any additional updates to the template, click Save in the top right corner

To create a Good Faith Estimate for Health Care Items and Services for a specific client:

  • Navigate to the client’s Overview page
  • Click New > Assessment
  • From the dropdown, select Good Faith Estimate for Health Care Items and Services

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  • Fill out the assessment
  • Click Save
  • Review the assessment
  • Click Sign > Sign & Lock
  • Once you’ve signed and locked the assessment, you can click Share to send it to the client for e-signature

share.simplepractice.GFE.png

Note: See Adding assessments, diagnoses, and treatment plans for additional details.

To share the recently completed Good Faith Estimate for Health Care Items and Services with a specific client at a later date:

  • Navigate to the client’s Overview page
  • Click Share in the top right corner
  • Select the checkbox for Good Faith Estimate for Health Care Items and Services under Your Signed Documents

GFE.simplepractice.share.png

  • Continue through by clicking the prompts in the bottom right corner
  • Click Share & Send Now to send the email

Note: See How do I share documents with existing clients? for additional details.

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Additional resources


FAQs


Are client signatures required on the consent document or the Good Faith Estimate?

Both the consent document and the Good Faith Estimate aim to protect clients by educating them about the differences between in- and out-of-network coverage. A signature on either document consents to the following:

  • I’m giving up some consumer billing protections under federal law.
  • I may get a bill for the full charges for these items and services, or have to pay out-of-network cost-sharing under my health plan.
  • I fully and completely understand that some or all amounts I pay might not count toward my health plan’s deductible or out-of-pocket limit.

Client signatures aren’t required on either the consent document or the Good Faith Estimate, however, if the client chooses not to sign, the provider can opt out of providing care and the client can proceed to find an in-network provider instead.


Is there a way to be reminded of when it’s time to update a Good Faith Estimate or when the amount estimated has been reached?


When will the Product team be allowing signatures on documents?

  • Our team is currently working on feature enhancements that will allow clients the ability to e-sign assessments, progress notes, and diagnosis and treatment plans via the Client Portal.
  • In the meantime, we recommend commenting and/or voting on this feature enhancement below on our Ideas and Suggestions board. That way, you’re notified via email when it's released.

Will the Good Faith Estimate for Health Care Items and Services assessment template be made available for customers on the Starter plan?

  • Customers on the Starter plan don’t have access to Assessments. At this time, there are no plans to enable customers on the Starter plan to access the Good Faith Estimates For Health Care Items and Services assessment template. Instead, we recommend that our Starter plan customers download these documents from cms.gov or from the Forms section of this Help Center guide. These documents can still be uploaded to a client’s profile and shared with them via the Client Portal. To do this, please see: How do I upload and share documents for individual clients?

Why can't the Good Faith Estimate for Health Care Items and Services assessment template be auto-filled similarly to a superbill? Why do we have to fill out information manually for each client?

  • The No Surprises Act requires that state-licensed and certified healthcare providers provide a Good Faith Estimate of charges to every new and continuing client who’s either uninsured or isn’t planning to submit a claim to insurance for the services that they’re seeking. The Good Faith Estimate includes client-specific information that qualifies as PHI, such as the client’s name, date of birth, and contact information. SimplePractice doesn’t currently have the functionality to auto-fill this information into an assessment or any other document for each client.

Why can’t I create an intake form to share with clients so they can easily sign the Good Faith Estimate?

It's important to note that the Good Faith Estimate should be an assessment since it’ll include client specific information like their name, date of birth, and diagnosis prior to the client completing the document. In order to accomplish this using an intake form, you'd have to include PHI on an intake form template, which we don’t recommend as it could potentially be shared with other clients in your account.


Why can’t I create an intake form to share with clients so they can easily sign the Good Faith Estimate?

It's important to note that the Good Faith Estimate should be an assessment since it’ll include client specific information like their name, date of birth, and diagnosis, prior to the client completing the document. To accomplish the same thing using an intake form, there would have to be PHI included in the template itself,  which we don’t recommend so as to avoid accidental sharing of PHI with other clients in your account. In order to accomplish this using an intake form, you'd have to include PHI on an intake form template, which we don't recommend as it could lead to accidental sharing of PHI with other clients in your account.


Forms

You can find a PDF version of both the consent document and the Good Faith Estimate from cms.gov below:

Still have questions?

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