Navigating the Good Faith Estimate for Outpatient Therapy Services

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Video Runtime: 68 Minutes; Learning Assessment Time: 43 Minutes

This course will teach participants what the good faith estimate (GFE) is, which insurance carriers and patients the GFE applies to, how it applies to cash-based therapy practices, and what the required elements of a GFE are. It will also explain the patient–provider dispute resolution process.

Learning Objectives

Apply the various definitions associated with §149.610 requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals
Choose the timeframes in which a GFE must be provided to an individual
Determine the required elements that must be included in a good faith estimate
Solve how a GFE can be delivered to an uninsured/self-pay individual
Apply the patient–provider dispute resolution process
Distinguish situations when a GFE may need to be issued to a patient inquiring about and/or receiving outpatient therapy services

Meet your instructor

Rick Gawenda

Rick Gawenda is founder and president of Gawenda Seminars & Consulting, Inc. He graduated in 1991 with a Bachelor of Science in physical therapy from Wayne State University in Detroit. Rick is director of finance for a physical therapist–owned private practice with multiple offices located in Southern California. In addition,…

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Chapters & learning objectives

1. Definitions Associated With the GFE

This chapter will teach the participants the definitions of applicable terms needed to understand the good faith estimate requirements.

2. Requirements and Timeframes

This chapter will teach participants the requirements of a provider and facility regarding the GFE as well as the timeframes in which a GFE must be given to a patient.

3. Required Elements of a GFE

In this chapter, viewers will solve how a GFE can be delivered to an uninsured/self-pay individual.

4. Patient–Provider Dispute Resolution Process

This chapter will teach participants the patient–provider dispute resolution process when the actual charges are $400 or more than the expected charges detailed in the GFE.

5. Situations That May Require a GFE to Be Issued

This chapter will teach participants possible scenarios when a GFE may be required to be issued to a patient inquiring about and/or receiving outpatient therapy services.

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