Good Faith Estimate Workflows & Suggestions

The CMS rule of the Good Faith Estimate has been difficult to implement. Do you have any workflows and suggestions to help health centers?

Starting January 1, 2022, FQHCs (and most other health care providers) will be required to provide uninsured persons with a Good Faith Estimate (GFE) of their expected out-of-pocket costs for services, if the individual schedules the service at least 3 business days in advance, or otherwise requests information about charges. These new rules have been proving challenging for FQHCs as the GFE must contain diagnosis codes, even if nobody at the CHC has yet met the patient.  The GFE must also contain the exact charge that a patient will pay for a service,  even if the FQHC has yet to determine what payment group the patient belongs to.  The workflow below may help your FQHC in determining the GFE.

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