Let’s imagine John walks into your clinic to consult with an orthopedic surgeon in your medical group. John has been having chronic pain in his right knee. The surgeon determines John may need surgery and orders lab tests and imaging to confirm his diagnosis. Test results are consistent with damage to the patient’s cartilage. The orthopedist recommends surgery.
When presented with payment options, John doesn’t have health insurance and elects to pay out of pocket (self-pay) for the procedure and all associated charges, including the consultation charges. And he requests an estimate.
Question: What should your office staff do to provide John with the estimate?
Answer: Staff needs to comply with requirements mandated by the Good Faith Estimate (GFE) for uninsured or self-pay individuals clause of the ‘No Surprises Act (2022)’ for all services scheduled or rendered in 2022 (beginning January 1). Put simply, staff need to provide John with an estimate of all costs that he is likely to incur.
Page 12 through 48 of the CMS bulletin https://www.cms.gov/files/document/gfe-and-ppdr-requirements-slides.pdf details all the stipulations pertaining to the GFE.
The stipulations set forth by this new law can be daunting and overwhelming for front office staff. Staff must be able to answer payment questions correctly. While some practice management systems (PMS) have developed tools that generate estimates, others have not.
AGS Health recently helped Tidewater Physicians Multispecialty Group provide medical procedure estimates via our patient cost estimation tool.
No Surprises Act: Price Transparency and Medical Estimates
AGS Health’s Patient Cost Estimation Tool
AGS Health developed a simple, affordable tool that quickly estimates costs for medical procedures. The tool is fully customizable. AGS’s Patient Cost Estimation Tool:
- Is simple to use and built on a program already installed on most Windows-based computer systems.
- Is interactive, allows for printing, and can easily be updated or customized to fit the end users’ needs.
- It is detached from and independent of larger PMS suites that providers might already be operating.
- Can reduce the risk of human error as long as the underlying fee schedules/charge masters are appropriately supplied during development and kept adequately updated.
“After struggling internally to meet requirements that provide Good Faith Estimates, we partnered with AGS Health to create a tool. Not only was it effective, but it was easy for the staff to learn quickly. We are confident we are now compliant with the new No Surprise Billing regulations.”
"After struggling internally to meet requirements that provide Good Faith Estimates, we partnered with AGS Health to create a tool. Not only was it effective, but it was easy for the staff to learn quickly. We are confident we are now compliant with the new No Surprise Billing regulations.” - Dinesh Pai, Chief Revenue Cycle Officer, Tidewater Physicians Multispecialty Group
Building this tool is just one of the many ways AGS works with healthcare organizations to optimize and improve their revenue cycle, while ensuring compliance with the many regulations and requirements imposed upon them.
To learn more about how AGS Health can help your organization, contact us.
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