What Do I Need To Know About the No Surprises Act Good Faith Estimate for Therapists?
Maybe you’ve heard a little about the No Surprises Act that went into effect in 2022…
Do you know what this means for your practice?
It’s easy to scroll through the emails and journals and not really digest the headlines coming your way. How do you even know which ones actually require your energy?
Clarity Cooperative supports therapists with the most important information you need to know. That’s why we’re going over the No Surprises Act and Good Faith Estimate in detail here. If you want more, we’ve got a post on Easy Ways for Therapists to Create a GFE, and a convenient GFE Calculator tool.
Since this legislation is relatively new, it’s understandable if you’ve got questions about how it affects you, and what needs to be done for the estimate.
Let’s dive deeper into what all of this change is about.
The No Surprises Act Good Faith Estimate for Therapists
Some surprises can be pretty nice – gifts, unexpected visits from loved ones, or a party in your honor. There are also ones that are quite the opposite, like unplanned expenses.
If you’ve ever sought out healthcare and were shocked by the fees due afterwards, or avoided it altogether because of costs – you’re not alone.
An overwhelming majority of healthcare consumers are shocked by medical bills, particularly those that pay out-of-pocket. A few states already had some measures in place to help with this, but it wasn’t enough. Federal action was deemed necessary and the No Surprises Act was born.
As part of this new law, the Good Faith Estimate (GFE) became a requirement for all healthcare providers. This includes therapists, as treatments for mental health and substance abuse disorders fall under the umbrella of this act.
Therapy Good Faith Estimate
Good Faith Estimates are essentially a quote that lists the services and associated fees a client can expect. Because therapy is typically ongoing, most providers will likely prepare one to cover a full year of appointments, and a new one is provided annually.
As a basic guideline, a GFEs include the client and therapist’s information, all expected diagnosis and treatment codes, frequency of sessions, and total costs.
If you want to easily create an accurate estimate, check out our GFE calculator tool which already includes diagnosis and treatment codes, and automatically totals the costs up for you based on your fees.
Situations Requiring a Therapy GFE
Let’s start off with some good news. Depending on the clients you see, not all of them will need a GFE. The ones that currently require it are those that are self-paying, uninsured, or choose not to use their insurance. Because clients that pay out-of-pocket tend to have the largest expense in regards to all healthcare services, they are the main focus of this legislation.
If you mostly see clients that are self-paying, we know it can seem like a lot of work added to your plate. That’s why we’ve created these resources and our GFE calculator tool to help you. We’ve got some tips further down to help you incorporate this process into your practice seamlessly.
Asking Clients About Health Insurance
A great first step is to ask about your client’s health insurance. If they happen to have coverage from a company that you work in-network with, you can save time and avoid creating an estimate for them altogether. The same applies for those enrolled in Federal healthcare programs like Medicare or Medicaid.
Asking if they know of any changes coming to their coverage can help you be prepared.
Their plan at the moment might be in-network, but let’s say they change jobs and are now out-of-network, or lose insurance completely. If the client continues working with you, you’ll have to provide a GFE.
Preparing Therapy GFEs for New vs. Existing Clients
Treatment plans and diagnosis codes can be hard to predict in certain cases, especially if you have a new client you’ve never met before. Since the guideline is to have the GFE delivered prior to their first booked session, the first one can include the initial consultation, a few follow up sessions, and what you expect their diagnosis to be. After getting to know the individual and their needs better, an updated GFE can be given then.
Existing clients are a bit easier to prepare GFEs for, as most of the time they will just need a new one every 12 months. If your fees have changed, those should be reflected as well as any new diagnosis and treatment codes. Keep in mind though, as we mentioned earlier, if any changes to the treatment plan occur the estimate may need to be updated.
Fluctuating Treatment Plans & Emergencies
It’s common for a client to increase or reduce the frequency of therapy sessions at any given time depending on events in their life. So you might be wondering, “How can I accurately predict what expenses will come up during an entire year?”
Let’s say for example, you’re having some repairs done to your home - the contractor can only provide you a quote based on the available information. If some hidden issues inside your walls come up after the work has begun, a new quote is provided.
Similarly, for a therapy client, a GFE can be provided based on the information you have at your disposal. Events that can’t be predicted, such as emergencies and unexpected appointments would not need to be included. If a treatment plan does get adjusted though, a new GFE should be provided.
Letting Clients Know a GFE is Available
It doesn’t have to be shouted from the rooftop, but it should be made known that GFEs are available.
You can practice letting prospective clients know that a GFE is available before setting up appointments. A great time to mention the GFE and gather extra information is during the consultation call.
Other ways to notify clients that an estimate is available is by posting notices in your office and on your website. These should be written clearly, accessible to the public, and available in languages that your clients are able to fully understand. Even better if it’s found easily through an online search of your website.
Building Client Trust
Since you’re on the receiving end of these financial transactions, it might not seem like such a big deal, but we know finances can be a huge trigger for stress or other issues for many people. If we were in the client’s shoes, it would probably feel nice and seem like the therapist was being very thoughtful if they gave us a GFE.
By providing this transparency in your fees and projected treatment plan, it can actually help build a stronger relationship of trust between you and your client. They’ll also be able to plan for the expected costs that come up within the year while having a feeling of empowerment over their finances and choices in healthcare.
Save Time Creating Therapy GFEs In Your Practice
If you have a lot of uninsured or self-pay clients, it might seem like a lot of paperwork to manage and keep track of.
A best-practice for you may be to provide new clients with a GFE right away, but set up regular intervals throughout the year to provide updated ones for existing clients. Depending on your work-flow an interval of weekly, monthly, or quarterly might work well for you.
To help streamline the process, use tools like our GFE Calculator. This calculator has been pre-filled with the most commonly used diagnosis and treatment codes, and you can even enter your own fees and frequency of sessions to get a total cost for the year. This can save you tons of time and potential headaches with trying to do math for multiple treatments and clients all at once.
Timing of Delivery
The No Surprises Act provides us with a timeline for GFE delivery to a client. It can seem like a lot of details so, as you read the guidelines below, try to keep a “three day rule” in mind.
For a new client, if the session is booked:
- 3+ business days in advance, the GFE must be delivered in 1 business day
- 10+ business days in advance, the GFE has to be delivered within 3 business days
- Less than 3 business days in advance, a GFE is not required prior to the appointment
If an estimate is requested by any individual (existing or prospective), a GFE must be provided within 3 business days. If a prospective client receives a GFE and waits awhile to book an actual appointment, an updated GFE should be provided within the time frames listed above. Any revisions that need to be made can be sent at least 1 business day prior to the scheduled session.
Approved Therapy GFE Delivery Methods
Therapists aren’t required to send the GFE via any specific delivery method, so here are the most likely options and suggestions regarding each.
Snail mail or the U.S. Postal Service is a federally operated and approved method of delivery. If your client prefers to receive correspondence via mail, this is perfectly acceptable. Letters are postmarked, and as long as it's dated within the timeframe listed (see above), it should be sufficient.
Though email isn’t necessarily a secure method of contact, unless encrypted, clients can consent to communication this way. If you prefer to keep a paperless practice, Electronic Health Record (EHR) systems are typically secure methods with portals that clients can access to retrieve records and messages.
Verbal delivery of a GFE can be done, but the estimate should still be put in writing and delivered to the client in one of the methods listed previously as confirmation.
When providing an annual updated estimate for ongoing clients, they can be presented with them at their appointment, or through the methods listed above as well.
Record Keeping and GFEs
If a client requests an old copy of an old GFE, would you know where to look?
Maintaining organized files and charts may not be the strongest skill for some of us, so it's important to point out that these estimates are an essential part of a client’s medical record. They are treated with the same importance as their progress notes.
Medical records are required to be kept securely for 6 years or for the length of time your local jurisdiction requires, whichever is longer. Therapists can keep track of each time an estimate was sent by recording the date and method of each delivery. This will help in case you or a client needs to reference an old GFE again.
It might seem like a smart move for your convenience to create a waiver for GFEs, but the law doesn’t include any exemptions regarding this. Some of your clients may also want to do the same, or refuse to sign the estimate itself.
Luckily, the document doesn’t require their signature and so as long as it's delivered, you’ve completed your part.
If the client refuses to sign a GFE and you find it uncomfortable to treat them under these circumstances, referrals to other therapists can be offered. Another option would be to let them know if they find a provider that is in-network with their insurance plan, they won't need to receive the GFE at all.
Flexibility in the Estimate
Remember that a Good Faith Estimate is exactly that – an estimate. As a therapist, you have some room for error within the total cost provided. The amount your client spends on sessions with you could end up being slightly more or less than estimated.
The only situation where you might feel some concern is when the total cost is over $400 more than on the GFE. The client does have the legal right to file a complaint with the Federal government and enter into a third party dispute resolution process.
If a client happens to file a complaint, you’ll be notified of this and then given 10 business days to provide the following:
- Copy of the client’s GFE
- Copy of the client’s bills
- Documentation to support that certain events contributed to additional fees and could not have been reasonably anticipated
Finding and Editing Errors
We’re all human – typos, misspelled words, and small mix-ups happen when we’re doing multiple things. To help minimize error, use our GFE Calculator tool, and try to work on one patient chart at time.
If you notice a mistake on a GFE that's already been delivered to a client, try to send a revised estimate as soon as possible. As we mentioned earlier, if you do need to make edits, it's good practice to have it delivered at least one business day before their first or next session. This way, they’ve been notified with enough time before coming into a different treatment plan or different payment than already expected.
Updating GFEs in regular intervals throughout the year and correcting errors as soon as you notice might seem tedious, but setting aside a few minutes to make sure you’re in compliance can avoid potential disputes later on. In the case you end up in a dispute process and need to provide documentation, you’ll already have everything in their record to easily pull up.
Supporting You with the No Surprises Act Good Faith Estimate for Therapists
At Clarity Cooperative we are here with the resources to help you navigate the requirements of the No Surprises Act and Good Faith Estimate.
Sign up for a risk-free two week trial to give our GFE Calculator tool a try, we know you’ll love it.
We also welcome you to come say hello to our community, where we support each other in doing what we love: helping our clients.
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