Good Faith Estimates and Patient Medical Records: What You Must Know

On Jan. 1, 2022, the No Surprises Act went into effect to protect consumers against unexpected medical bills. Such bills were common if patients received healthcare services from out-of-network physicians and facilities.

One of the key provisions under the No Surprises Act requires providers and facilities to provide Good Faith Estimates (GFEs) of healthcare charges to individuals. As more physicians and institutions continue complying with the provisions outlined in the Act, a major question has emerged about whether you should include GFEs in your patient medical records.

This article delves into applicable federal regulations that clarify good faith estimates and their role in patient medical records.

{{toc}}

What’s a good faith estimate?

A Good Faith Estimate is a notification outlining the charges a self-pay or uninsured individual can expect to pay for a requested or scheduled healthcare service or item. The No Surprises Act requires providers and facilities to give these estimates at least three days before a consumer can receive the specified service or upon request.

GFEs aim to prevent consumers from being caught off guard by surprise expenses. The best part is that consumers who get the estimates can initiate a dispute resolution process if the actual charges are $400 or more than what was shown in the GFE.

The No Surprises Act requires you to provide GFEs to self-pay or uninsured individuals even if they intend to seek healthcare services from an alternative provider or facility. The GFE contains the patient’s information and diagnosis, a list of expected charges, and itemized estimates from providers. When providing the estimates, you should focus more on the accuracy of diagnosis codes, service codes, and expected costs.  

Do good faith estimates have to comply with HIPAA?

Good faith estimates have to comply with the HIPAA privacy rule. The rule requires healthcare organizations and providers to keep patient records and sensitive patient information safe. The rule also gives individuals the right to control how entities that hold their health information can use it.

The GFE provision doesn’t change a facility’s or provider’s requirement to comply with the set Federal and State laws, including HIPAA. When issuing GFEs, you should take steps to ensure the security and privacy of the information you disclose in the estimate. That means you should follow the appropriate safeguards to protect the privacy of the health information contained in the GFE.

Good faith estimates are part of a patient’s medical record

The law, as per 45 CFR 149.610(f)(1), stipulates that GFEs issued to self-pay or uninsured individuals are part of a patient's medical record.

As a convening provider or facility, the law requires you to provide a copy of any good faith estimate issued in the last six years to an uninsured or self-pay individual upon request. This means you must keep copies of GFEs for at least six years because you never know when an individual might need access to the estimations.

Generate, send, and securely store GFEs with MD Clarity’s Clarity Flow

Penalties for non-compliance with good faith estimates can be hefty, including a fine of up to $10,000 per offense. To ensure you stay compliant with the law, consider automated solutions such as MD Clarity’s Clarity Flow.

Clarity Flow software will automatically generate and deliver GFEs by mail, text, or email to ensure you comply with the No Surprises Act. Request a demo today to see how MD Clarity's software can automate compliance.