13. Good faith estimates for cash-pay practices
Cash-pay founders Planned episode, the cash-pay practice. What the federal requirement means for a cash-pay practice.
Listener title: Good faith estimates in a cash-pay practice
Listener description: A health care attorney explains what the federal good faith estimate requirement means for a cash-pay practice: who receives an estimate, when it is due, what goes in it, and how practices build it into scheduling. For founders of direct primary care, concierge and other cash-pay practices. The episode is general information, not legal advice; take your own situation to your own counsel.
Run of show (about 40 minutes)
| Time | Segment | What happens |
|---|---|---|
| 0:00 to 2:00 | Opening | Host introduces the topic and the guest. The guest discloses any industry relationships. Host notes that the episode is general information, not legal advice, and that guests speak for themselves. |
| 2:00 to 8:00 | Who receives an estimate | Which patients in a cash-pay practice are eligible, and how should a practice think about insured patients who choose not to use their coverage? The attorney explains, using the CMS guidance listed on the network's good faith estimate page. Host raises the question that page leaves to counsel: whether a direct primary care or concierge membership fee itself needs an estimate. |
| 8:00 to 17:00 | When it is due and what goes in it | When is an estimate due, and what goes in it? The attorney walks through the timing in the CMS guidance and the content of the CMS model form, and explains what the patient-provider dispute process means for a practice. |
| 17:00 to 27:00 | Building it into scheduling | How have practices built the estimate into scheduling? Host and guest discuss who prepares it, what triggers it, how it reaches the patient and how it is kept. What happens when the plan of care changes after the estimate is given? |
| 27:00 to 36:00 | Questions to take to counsel | What questions should a founder take to counsel? Host and guest build the list: the membership-fee question, recurring or ongoing services, care that involves other providers or facilities, and anything specific to practicing in Colorado. |
| 36:00 to 40:00 | Closing | One practical takeaway: download the current CMS model form from CMS before use, and bring your scheduling workflow and the membership-fee question to your own counsel. To reach the network, email hello@coloradocarenetwork.com with a topic in two sentences; physicians and APPs can express interest on the Join page, coloradocarenetwork.com/join/; members can post in #podcast on Slack. |
Guest prep questions (sent to the guest a week ahead)
- Which patients in a typical cash-pay practice are eligible for a good faith estimate, and how should a practice think about insured patients who choose not to use their coverage?
- The network's good faith estimate page leaves one question to counsel: whether a direct primary care or concierge membership fee itself needs an estimate. How would you frame that question for a founder, without advising any one practice?
- Please walk us through the timing and content of an estimate as the CMS guidance and model form set them out. Where have you seen practices most often go wrong?
- What does a workable scheduling process look like: who prepares the estimate, what triggers it, how it reaches the patient and how it is kept?
- What should a founder bring to their own counsel, and are there Colorado-specific questions they should ask?
Show notes
A health care attorney walks through what the No Surprises Act good faith estimate means for a cash-pay practice: who receives one, when it is due, what the CMS model form contains, and how practices build it into scheduling. The episode closes with a list of questions for founders to take to their own counsel, including whether a membership fee itself needs an estimate. This is general information, not legal advice.
- Sources and tools:
- Good faith estimate, https://coloradocarenetwork.com/practice/good-faith-estimate/ : "What the No Surprises Act requires for uninsured and self-pay patients, and where to get the CMS model form"
- CMS model notice, "Good Faith Estimate for Health Care Items and Services": cms.gov/files/document/good-faith-estimate-example.pdf. Download the current version from CMS before use.
- Consumer and provider information: cms.gov/nosurprises
- Centers for Medicare & Medicaid Services. Good faith estimate and patient-provider dispute resolution process for uninsured or self-pay individuals. December 21, 2021. https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/good-faith-estimate-patient-provider-dispute-resolution-process-for-uninsured-or-self-pay-individuals.pdf
- Centers for Medicare & Medicaid Services. Standard form: Good Faith Estimate for Health Care Items and Services under the No Surprises Act (Appendix 2). OMB 0938-1433. https://www.cms.gov/files/document/good-faith-estimate-example.pdf
- No patient information is discussed on this episode.
All planned episodes. To be the guest for this episode, email hello@coloradocarenetwork.com with the episode number.