Good Faith Estimate FAQs
We get it, the specifics of the GFE Mandate can be confusing. Below, we've addressed the most common questions we receive.
What is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a notification that outlines a self-pay/uninsured individual’s expected charges for a scheduled or requested item or service. Providers and facilities must give this estimate to a self-pay/uninsured individual (or their authorized representative) who requests it or who schedules an item or service. The Good Faith Estimate will also include items or services reasonably expected to be provided along with the primary item(s) or service(s), even if the individual will receive the items and services from another provider or another facility.
This request is for all items or services that are reasonably expected to be provided from admission through discharge. Separate Good Faith Estimates would be provided upon scheduling or upon request for any items or services that are necessary prior to or following provision of the primary item or service beyond the period of care (e.g., pre-operative laboratory tests or post-discharge physical therapy).
How is the Good Faith Estimate different from estimates we are currently creating for patients?
Good Faith Estimates require an estimate on all services associated with the scheduled procedure regardless of if the providers are employed by the convening provider or considered outsourced providers. These estimates must be delivered to the patient within 24-72 hours.
Estimates that have been supplied to patients over the last decade typically were for hospital services only, physician services only, or combined if the performing physician was employed by the hospital where the hospital sets the fee and negotiates the reimbursement with the payers. These estimates historically do not have a time deadline for patient receipt.Currently, CMS is mandating Good Faith Estimates for self-pay/uninsured patients only whereas traditional estimates may include estimates for patients with insurance.
What is the required time frame to present a Good Faith Estimate to a schedules self-pay/uninsured patient?
Upon receiving a request for a Good Faith Estimate from a self-pay/uninsured individual or upon scheduling a primary item or service for a self-pay/uninsured individual, the convening provider or convening facility must contact all co-providers and co-facilities who are reasonably expected to provide items or services in conjunction with, and in support of, the primary item or service no later than 1 business day after scheduling or receiving the request. The convening provider or convening facility must request that the co-providers or co-facilities submit Good Faith Estimate information to the convening provider or facility.Convening providers and facilities must provide a Good Faith Estimate to self-pay/uninsured individuals within the following timeframes:
Scheduled Patients: When a primary item or service is scheduled at least three business days before the date the item or service is scheduled to be furnished, the Good Faith Estimate must be provided no later than one business day after the date of scheduling.When a primary item or service is scheduled at least ten business days before such item or service is scheduled to be furnished, the Good Faith Estimate must be provided no later than three business days after the date of scheduling.
Patients Not Scheduled: When a Good Faith Estimate is requested by a self-pay/uninsured individual, the Good Faith Estimate must be provided no later than three business days after the date of the request.
How do you define convening provider and co-provider?
A convening provider or convening facility is the provider or facility who schedules an item or service or who receives the initial request for a Good Faith Estimate from a self-pay/uninsured individual.
A co-provider or co-facility means a provider or facility other than a convening provider or a convening facility that furnishes items or services that are customarily provided in conjunction with a primary item or service.
For example, a patient may be going into a hospital for a Total Hip Replacement. The hospital is the convening provider. The orthopedic surgeon, anesthesiologist, radiologist are co-providers.Or a patient may have a mole removal scheduled at their dermatologist which would be a physician office. The dermatology practice is the convening provider. The pathology services associated with the procedure is the co-provider.
Do we have to create a Good Faith Estimate for every patient that is scheduled for services?
No. Currently, CMS is mandating Good Faith Estimates for self-pay/uninsured patients only. We believe that CMS will eventually mandate a Good Faith Estimate for all patients to include insured, Medicare and other governmental programs such as Tricare and VA.
Do we have to create a Good Faith Estimate self-pay/uninsured patients who are not scheduled, but shopping?
Yes. CMS requires Good Faith Estimates for self-pay/uninsured shopper estimates.
What happens if something changes on the Good Faith Estimate before the date of service, such as procedure or provider?
If a convening provider, convening facility, co-provider, or co-facility anticipates or is notified of any changes to the scope of a Good Faith Estimate (such as anticipated changes to the expected charges, items, services, frequency, recurrences, duration, providers, or facilities) previously furnished at the time of scheduling, the convening provider or convening facility must provide the individual with a new Good Faith Estimate no later than 1 business day before the items or services are scheduled to be furnished. If any changes in expected providers or facilities represented in a Good Faith Estimate occur less than 1 business day before the item or service is scheduled to be furnished, the replacement provider or facility must accept the Good Faith Estimate for the relevant items or services being furnished that was provided by the replaced provider or facility.
What about recurring services such as a plan of care for chemotherapy or physical therapy? Can I create one Good Faith Estimate, or will I need to create separate Good Faith Estimates for each visit?
A convening provider or convening facility may issue a single Good Faith Estimate for recurring primary items or services if both of the following requirements are met:
The Good Faith Estimate for recurring items or services includes, in a clear and understandable manner, the expected scope of the recurring primary items or services (such as timeframes, frequency, and total number of recurring items or services).
The scope of a Good Faith Estimate for recurring primary items or services does not exceed 12 months.
Will the CMS be monitoring for Good Faith Estimate compliance?
Yes. How, we do not know. But based on past transparency mandates, CMS actively monitors, warns, and fines providers not in compliance.
If we use outsourced providers for some of our services such as Anesthesiology or Pathology, how will they contribute to the Good Faith Estimate via The Hyve - The Hyve - GFE Exchange?
During implementation, your team will provide Collectyve Health with your provider list (employed and outsourced). Once received, Collectyve Health loads that data into The Hyve – GFE Exchange platform. Your users will select the appropriate co-providers for the scheduled service within the The Hyve – GFE Exchange. The administrative staff associated with the selected co-providers will receive an email requesting login into The Hyve – GFE Exchange to complete the estimate. As this is one portal for all, the good faith estimate process lives in one location while it is being completed. The convening provider is notified when complete and sends the estimate to the patient.
Why can't I just call the outsourced provider to get the rate for their component of the good faith estimate and manually enter it into the estimate?
Calling each provider associated with the service is time consuming and inefficient. Often, the co-provider will need to call the convening provider back with the information and may forget to do so. The Hyve – GFE Exchange monitors the due date and sends reminder emails to the co-provider to complete the estimate. This means the convening provider can initiate the GFE request and move on to do other work while the co-provider is completing their portion.
Additionally, each party is responsible for their transparency. Having the co-provider enter their rate absolves the risk of the convening provider entering in the rate for the co-provider incorrectly and then being liable for any penalties/audits associated with that incorrect rate. Each team member owns their own process.
How does a co-provider know there is a good faith estimate request?
Once the convening provider initiates a new estimate and fills out the convening provider information (patient demographics, scheduled procedure, due date of estimate), enters the co-providers and submits the estimate, a “New Estimate” email goes out to each of the co-providers listed on the estimate with a call to action.
There may be many co-providers associated with a service. Do I have to create unique estimates for each co-provider then merge them together when completed?
No. You will enter all co-providers associated with that service into the estimate and select Submit Estimate one time. Each provider will receive notification, and each will enter their appropriate information for that estimate. In the estimate, you will see the status for each provider (draft/new, completed and declined). All providers are coming together via our technology to create one good faith estimate.
I don't have enough time to monitor and repeatedly follow up on a request to co-providers after a GFE request has been sent. How does The Hyve - GFE Exchange monitor response?
When the convening provider submits an estimate request to the co-provider, the co-provider receives an email stating a new estimate request is ready to complete, with a link to the actual estimate in The Hyve – GFE Exchange. Each estimate has a due date/time. If the estimate has not been completed by the co-provider 12 hours before the due date/time, another email goes to the co-provider listed as urgent. If the co-provider fails to complete the estimate on the due date/time, an overdue email alerts both the co-provider and convening provider. At this point, the convening provider prints the estimate to give to the patient as an incomplete estimate. The Hyve – GFE Exchange handles all the monitoring and reminder emails for you so you and your team can do other work.
What if the co-provider has a question for the convening provider that needs an answer before they complete their portion?
The Hyve – GFE Exchange has a chat feature where convening providers and co-providers can ask and receive information from each other to help complete the estimate without going to an outside tool.
What happens if the co-provider does not contribute the good faith estimate request? Who is at risk of non-compliance?
The Hyve – GFE Exchange shows when the request was submitted to the co-provider, if the co-provider declined the request, or if the co-provider did not respond at all to the request. This provides an audit trail. Additionally, the GFE letter presented to the patient will show an incomplete estimate, highlighting the co-providers who did not participate. The co-provider becomes the provider at risk of non-compliance, not the convening provider.
We don't have time for classroom training for The Hyve - GFE Exchange nor can we train our outsourced co-providers. How do you handle training?
All training is on-demand video training and specific to user role such as convening provider or co-provider. Training lasts no longer than 30 minutes and is accessed via The Hyve – GFE Exchange site with a user login/password. This allows providers to train when ready and to train new hires as needed. Collectyve Health monitors who have completed training. We also offer live Q and A sessions the first 2 weeks post-go live to assist with user adoption.
Who are the users of The Hyve - GFE Exchange? Clinical providers or administrative staff?
While we require a listing of all clinical providers to build your provider list within The Hyve – GFE Exchange for co-provider selection, the actual users are typically provider administration staff such as patient access, patient financial services, scheduling, registration and physician office administration.
Is The Hyve - GFE Exchange only available for specific EHR, HIS systems?
No. The Hyve – GFE Exchange is agnostic to all EHR/HIS.
Still have questions?
If you still have questions regarding the GFE Mandate or The Hyve - GFE Exchange, please reach out to our team!
