The No Surprises Act went into effect January 1, 2022. One of its core provisions — the Good Faith Estimate (GFE) requirement — applies directly to independent OT, PT, ST, optometry, and ophthalmology practices. And most small practices still aren't doing it right.
This isn't meant to scare you. It's meant to give you a clear picture of what the law requires so you can fix it before it becomes a problem.
What Is a Good Faith Estimate?
A Good Faith Estimate is a written document that tells a patient — before their scheduled service — what they can expect to pay. It's not a final bill, and it's not a guarantee. It's an honest estimate of costs, in writing, before care is delivered.
Who Has to Receive One?
This is where a lot of practices get confused. GFEs are required for:
- Uninsured patients — anyone without any health coverage
- Self-pay patients — patients who have insurance but are choosing not to use it for a particular visit
- Any patient who asks — if an insured patient requests a GFE, you're required to provide one within 3 business days
The key thing to understand: this isn't just for your uninsured patients. Any patient can ask for a GFE, and you have to provide it.
What Has to Be In It?
A compliant GFE must include:
- Your name, address, NPI, and TIN
- A clear description of the primary service(s)
- Relevant diagnosis codes (ICD-10) and service codes (CPT)
- The expected charges for each service
- If multiple providers are involved, estimates from each
- A statement of the patient's right to dispute the bill if it exceeds the GFE by more than $400
- The date the GFE was issued
It must be provided at least 1 business day before a scheduled service. If a patient schedules within 3 days of the appointment, you still must provide it within 1 business day of scheduling.
When Does the $400 Rule Apply?
If your final bill comes in more than $400 above what you estimated on the GFE, the patient has the right to initiate a federal patient-provider dispute resolution process. In most cases, this means an independent arbitrator reviews the dispute — and the practice typically loses.
This isn't just a theoretical risk. As patients become more billing-aware, disputes will increase.
What Most Practices Are Doing (And Why It's Not Enough)
In our conversations with small practice owners, we've seen four common approaches — none fully compliant:
The Word Doc approach. A staff member fills out a template manually for each patient. Problems: inconsistent, no audit trail, easy to forget required fields, no retention system.
The verbal estimate. "We tell them it'll be around $X." Problems: not written, no record, not legally compliant at all.
The spreadsheet. Better than nothing, but rarely includes all required elements or a retention workflow.
Nothing. More common than you'd think. "We haven't had any complaints" isn't a compliance strategy.
What Happens If You Don't Comply?
The HHS Office for Civil Rights is the enforcement body. Penalties can reach $149 per violation — meaning per patient who didn't receive a GFE when they should have. For a practice seeing 20 self-pay patients a month, non-compliance could mean thousands in annual exposure.
Beyond penalties, the $400 dispute threshold is where the real financial risk sits. If a patient initiates a dispute and you can't produce a GFE that matches your billing, you're in a difficult position.
The Fix Is Simpler Than You Think
A compliant GFE workflow doesn't have to be complicated. At minimum, you need:
- A written template that includes all required fields
- A process for identifying which patients need a GFE before each visit
- A way to deliver it at least 1 business day before the appointment
- A retention system that keeps a copy for 6 years
For most small practices, this can be handled with the right template and a 2-minute front desk workflow. For practices seeing higher volumes of self-pay patients, a simple custom tool that generates GFEs from your fee schedule makes more sense.
Where Degnys Can Help
We've built GFE compliance solutions for independent practices at two levels:
Template Package — Compliant, specialty-specific GFE templates pre-filled with your service codes and required disclosures. Ready to use immediately. Good for practices with low self-pay volume.
Custom GFE Tool — A lightweight internal web app your front desk uses to generate a compliant GFE in under 2 minutes. Select patient, select services, click print. Logs every estimate automatically for your 6-year retention requirement.
Either way, we start with a compliance audit so you know exactly where your current workflow falls short.
Want to know where your practice stands? Book a free practice audit and we'll review your current GFE workflow as part of it.