4 steps PT practices need to take to produce good faith estimates

April 18, 2022

Physical therapy is a necessary step for the recovery of many patients. As such, most private insurers, workers’ compensation insurance, medicare and medicaid will cover the costs of physical therapy, leaving patients responsible for only a small copay. In some cases, patients may pay nothing at all out of pocket. But what about patients who are not covered by insurance?

There may be a number of reasons that a patient may be paying for physical therapy out of pocket. Their insurance provider may not consider physical therapy as medically necessary for them at that time. Your practice may not be “in-network,” or the patient may have no health insurance coverage at all. Health care providers are required to give self-paying patients an estimate of the amount they will be billed.

According to the No Surprises Act, a bill that was passed in 2020, providers are required to provide clear and concise good faith estimates to all uninsured patients before any nonemergency procedure. This prevents patients from being hit with bills that they did not expect and may not be able to pay.

 

How does the No Surprises Act apply to a physical therapy practice?

According to the Department of Health and Human Services, all forms of health care are affected by the No Surprises Act, including physical therapy. There are a few simple guidelines that must be followed when providing patients with a good faith estimate:

  • Services must cost no more than $400 more than the cost given in the patient’s estimate. The patient can dispute any charges that are more than this amount.
  • Uninsured and self-pay patients must be informed that they will be receiving a good faith estimate before their treatment. This information can be given upon request, or upon making an appointment with your practice.
  • Good faith estimates must be made available in the patient’s spoken language, and must be written in a clear and concise way. They must be delivered to the patient as either a paper document or an electronic file.
  • Estimates must factor in all financial assistance for which the patient might be eligible. This may include elderly and veteran discounts, as well as financial assistance programs.
  • Good faith estimates must remain on file for six years as a part of the patient’s medical records. However, the estimates are considered expired after one year and must be reissued if the patient seeks treatment after that time.

 

What is the simplest way that I can provide good faith estimates to my patients?

Providing your patients with a good faith estimate before care benefits both your patients and your practice. Knowing that they will not be presented with surprise costs helps to build your patients’ trust. Here are four steps that your practice can take to provide your patients with good faith estimates:

  1. Review all guidelines from the No Surprises Act — All of the guidelines that physical therapy providers need to follow are available through the Centers for Medicare and Medicaid Services. It is important to make sure that all guidelines are followed, or patients will be able to dispute costs.
  2. Inform your patients of their rights — Uninsured and self-pay patients may not be aware of the No Surprises Act. Informing your patients of their right to a good faith estimate when they visit your practice is a good way to build their trust. Posting information where patients can easily see it in your office is another step you can take to keep your patients informed.
  3. Determine which patients need an estimate — It is important to make sure that you are providing estimates to all eligible patients. While many of your patients may have health insurance, your services may not always be covered. Those patients would require a good faith estimate.
  4. Create a standardized form for your practice — A good way to provide concise estimates to your patients is to create a standardized form. This form should be available in multiple languages and should be easy to read. This will help to avoid confusion, which could lead to patients disputing their costs.

 

Where can my practice turn for help staying compliant?

Alliance Physical Therapy Partners can offer you the guidance and support your practice needs to stay compliant under the No Surprises Act. Compliance and billing support, direct marketing, acquisition support, and professional development are just a few of the services that Alliance PTP can offer to our partners. We are dedicated to providing our partners with the tools, resources and expertise to succeed.

 

Contact our team today for more information about how we can help your practice or to find out how you can join our partnership in care.