AUCH Finance Peer Group

GFE Estimates- CMS Updates issued December 27, 2022 

01-05-2023 14:20

The attached guidance/FAQ from CMS (issued December 27, 2022) provides important information for FQHCs providing GFE estimates for uninsured and self-pay patients including for:

  • New patients
  • Established patients
  • Visits that result in no charge

For new patients, you can provide them a GFE with a schedule of expected charges for the different sliding fee categories (see an example of such below). You do not have to identify their income and family size before the visit.

For established patients, you can provide them with a GFE based on the income and family size you have in your most recent records for that patient. For these GFEs, CMS recommends including a disclaimer letting the patient know that the GFE is based on what you have in your records and, if the individual’s circumstances have changed since the last visit, the GFE would need to be adjusted accordingly.

For patients coming in for a visit where there is no expected charge, the CMS guidance (attached) includes a template Good Faith Estimate for No-cost Health Care Items and Services. It is significantly shorter than a typical GFE.

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