Physicians Share Fears Surrounding Good Faith Estimates

With the No Surprises Act well underway, the Workgroup for Electronic Data Interchange (WEDI) recently conducted a survey polling medical providers about the challenges relating to Good Faith Estimates. A Good Faith Estimate (GFE), in relation to the No Surprises Act (NSA), is meant to keep insured patients informed of their expected costs when undergoing medical treatments. The GFE is required to include all costs for services and associated items, including costs from all providers and entities providing care. Once a GFE is sent to the payer, an advanced explanation of benefits is shared with the patient.

Currently, there is no standardized data exchange process for the convening provider or facility requirement. The survey respondents – a variety of practitioners from small practices to large health systems – shared feedback about the perceived difficulty of implementing the convening provider/facility requirement.

Notable results from the WEDI survey include:

• 66% responded that it may be very difficult or difficult for providers and facilities to determine the convening provider/facility
• 89% responded that it may be very difficult or difficult for the convening provider/facility to identify all appropriate co-providers and/or facilities for a specific medical service
• 91% responded that it may be very difficult or difficult for the convening provider/facility to collect GFEs from co-providers and/or facilities for a specific medical service
• 89% responded that it may be very difficult or difficult to complete the GFE process for a specific medical service and provide this information to the patient or health plan within this required timeframe of three business days of the service being requested or scheduled

Although the No Surprises Act aims to provide consumer protections and will provide benefits to many healthcare consumers, it also has the possibility to complicate the operations of the nation’s medical practices and hospitals.

“The survey results suggest providers and facilities will face significant challenges,” stated Charles Stellar, WEDI President and CEO. “Survey respondents were adamant that meeting the legislation’s three-day deadline to get the GFE to the patient would be difficult or very difficult. Not surprising, respondents expressed strong support for the government delaying the convener requirement until a standardized process to exchange data between convening providers and co- providers/co-facilities is established.”

To stay up to date on the latest regulations affecting the No Surprises Act, visit the TriZetto Provider Solutions resource center.