No Surprises Act & Good Faith Estimates
If you were surprised by the No Surprises Act, you weren't alone. This law went into effect January 1, 2022 and contains a complex set of mandates for all licensed or certified psychotherapists (regardless of accepting insurance or not).
Don’t panic! As a TherapyAppointment user, there's good news: we've automated most of the process within Online Forms. Simply update our provided template and set the form to Auto-Assign to send to new clients automatically.
To learn more about this law in general and how it impacts therapists, click here.
- When a Good Faith Estimate (or GFE) is necessary
- Timelines for compliance
- and the information required to be in a GFE
Note: On April 1st, 2022, Clarifications to this law were made by CMS.
What's included in this article:
- Using and Updating TherapyAppointment's Provided "Good Faith Estimate Template"
- Assigning at Intake Without a Diagnosis/Treatment Plan
- To Comply by Mail
Using and Updating TherapyAppointment's Provided "Good Faith Estimate" Template
- Either click here
- Navigate to Online Forms (Practice Settings ➝ Online Forms ➝ New Forms)
- Then scroll down to the "TherapyAppointment Provided Forms" Section.
- Locate the Good Faith Estimate Template (highlighted the red box below).
Client Information will be automatically filled in when the client submits the form
This information will be pulled from the client's profile and upon submission of the completed form the following data will automatically:
- Client Legal Name (First, Last)
- Date of birth
- Client Address
It must be marked as completed under their Docs & Forms tab, or you will still see something similar to below:
***Please note, this document MUST be modified for your practice to comply.***
Assigning at Intake Without a Diagnosis/Treatment Plan
If assigning prior to meeting the client for the first time, you likely will not have a diagnosis and an expected course of treatment.
Diagnosis: This is actually to your advantage! Simply report the diagnosis of “R69” which translates as “diagnosis deferred”--no need for tailoring to this particular client.
What if the referral is not for psychotherapy? What if, for example, you are being asked to perform a standardized psychological evaluation? Then you should substitute appropriate CPT codes, descriptions, and prices for such an evaluation to the best of your ability.
Course of Treatment: This is a Good Faith Estimate, so giving a total of an average course of therapy is sufficient for a client you have not met. APA reports that, on average, psychotherapy lasts for 18 sessions, making this a reasonable estimate.
To Comply by Mail
So, if you prefer to do this the Luddite way (on paper and mailed to them promptly), your form for traditional psychotherapy could look like this:
Name:________________________________ Date of Birth:_________________
You have been referred to my office for treatment. I’m required to give you a Good Faith Estimate of the cost of treatment if you are uninsured or don’t want to use insurance for this care. Since we haven't met, and don’t yet know if you want to use insurance for your treatment, the information below is based on “fee for service” (out of pocket) rates.
If you DO intend to use insurance, check with your insurance carrier to find out what your copayment or coinsurance rates will be–they are likely to be much smaller.
Since I have not yet evaluated your difficulties or symptoms, I must at this point estimate your course of treatment based upon the national average for a course of psychotherapy, which is 18 encounters.
This initial estimate is valid for 12 months, but you are entitled to receive an update on this estimate at any time upon request.
Current ICD-10 diagnosis: R69 (diagnosis deferred).
1 session of CPT 90791 (diagnostic evaluation) at [ Your rates here]
17 weekly sessions of CPT 90834 (psychotherapy, 45 minutes) at [ Your rates here] per session
Total of estimated “fee for services” treatment without insurance: [ Your rates here]
This is just a rough estimate based on national averages. The duration of our work together can be longer or shorter depending upon your symptoms, your work between sessions, and your response to treatment.
Unless required by a court order (an extremely rare situation), you are free to discontinue treatment at any time, and free to discuss any other modifications to treatment modalities, frequency, or duration. You are ultimately in control of your own healthcare; I am just here to provide help at your request.
Location of treatment: All sessions will take place in my office at [Your address here/Online]
My identifying information:
[Your name here], [Credentials]
National Provider Identifier: [NPI number here]
Tax ID number: [Tax ID Number here (do NOT provide your social security number if you are using this for your practice's Tax ID number)]
This information should not be constituted as legal advice. Information surrounding compliance of the No Surprises Act is vague at this point. If you have questions about compliance and regulations, please visit the CMS.gov or speak to your practice's attorney.