Laws and Regulations Affecting Practice

Good Faith Estimate (GFE)

UPDATE: May 21, 2022

Peggy Chapman, Chair Legislative Committee,  has graciously researched both Massachusetts and Federal policy re: the Good Faith Estimate regulations.  An estimate of all non-emergency costs  must be given to all patients who have insurance at EACH appointment. An alternative is to give one notice for a set of appointments as you will see in the example.  Starting July 1, 2022,  a fine can be levied against any clinician who does not do this for patients who have insurance that a provider is not empaneled with.  The rule actually started on Jan. 1, 2022. Peggy Chapman’s form incorporates the required language of both the federal and state regs.


Frequently Asked Questions (FAQs) regarding implementation of Section 112
of Title I (the No Surprises Act (NSA)) of Division BB of the Consolidated Appropriations Act,
2021 (CAA 2021), and implementing regulations published in the Federal Register on October 7,
2021 as part of interim final rules with comment period, entitled “Requirements Related to
Surprise Billing; Part II.” These FAQs have been prepared by the Department of Health and
Human Services (HHS) to address the provision of GFEs for uninsured (or self-pay) individuals,
as described in Public Health Service Act (PHS Act) section 2799B-6 and implementing
regulations at 45 CFR 149.610. (Read more…)

Fine Print:

Diagnosis is only required for calculation of costs for uninsured not as a formal diagnosis