The Abbreviated Good Faith Estimate (AGFE) was recently released to reduce the burden on healthcare providers to provide full-length GFEs to patients who won’t be charged. The new AGFE allows facilities to comply with the No Surprises Act while requiring less information.
Under the No Surprises Act, a Good Faith Estimate (GFE) must be provided to patients who don’t have health insurance or to those who plan to pay out of pocket. This GFE must include detailed information about the items and services, such as diagnosis codes, the facility that provides them, and the expected costs and charges.
Provided that all other requirements under 45 CFR 149.610 are met, the following conditions are required when using an AGFE:
- The uninsured (or self-pay) individual is provided with an abbreviated GFE
- The uninsured (or self-pay) individual who receive an AGFE is not billed
- No items or services included in the AGFE are expected to be furnished by co-providers or co-facilities in conjunction with the primary items or services.
Further, an AGFE must include the following elements:
- Patient name and date of birth
- Name, National Provider Identifier (NPI), and Taxpayer Identification Number (TIN) of the provider or facility, and the state(s) and office or facility location(s) where the items or services are expected to be furnished by the provider or facility
- If scheduled, the date(s) the items or services are scheduled to be furnished
- A statement that the provider or facility will not bill the individual for any items or services furnished on the date(s) the scheduled items or services are scheduled to be furnished (if scheduled) or that the provider or facility will not bill the individual for any items or services (if no date(s) of service is scheduled and the GFE is being provided upon request)
- A disclaimer that informs the uninsured (or self-pay) individual of their right to initiate the PPDR process if the individual is charged by the provider or facility for items or services furnished on the date(s) listed on the abbreviated GFE (or in the case of a GFE based on request, if the individual is charged by the provider or facility for any items or services), and the actual billed charges are $400 or more. This disclaimer must include instructions for where an uninsured (or self-pay) individual can find information about how to initiate the PPDR process and state that the initiation of this process will not adversely affect the quality of health care services furnished to an uninsured (or self-pay) individual by a provider or facility
- A disclaimer that the GFE is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from any of the providers or facilities identified in the GFE
- A disclaimer that informs the uninsured (or self-pay) individual that there may be additional items or services the convening provider or convening facility recommends as part of the course of care that must be scheduled or requested separately
Additional information about AGFEs, including a template AGFE, can be found in the 2021 FAQs About Consolidated Appropriations Act.