Surprise Billing FAQs, MGMA

Still confused about Good Faith Estimates (GFE)?

Does Qualifying Payment Amount (QPA) sound like Greek?

GOOD FAITH ESTIMATE

Effective 1/1/2022

Beginning January 1, 2022 if a patient is UNINSURED or pays their own medical bills (if you don’t submit a claim to a health plan) the Provider MUST provide the patient with an estimate of expected charges BEFORE they provide the item or service. 

It’s called a Good Faith Estimate (GFE).

Sample Insurance Restriction form (simple)

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Sample Insurance Restriction form (Complex) 2/22/2021

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Self-Pay Insurance Restriction Sample Policy 2/22/2021

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Medicare Benefit Policy Manual Chapter 15.40 Revised 8/7/20

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Self-Pay Medicare Beneficiary

Protect Your Patient…  Protect Your Practice…  Protect Yourself
When a Medicare Beneficiary wants to pay out of pocket?