- Home
- Advocacy
- Latest News and Practice Data
- CAP Releases Good Faith Estimate Toolkit for Pathologists
In April, the Centers for Medicare & Medicaid Services (CMS) released good faith estimate requirements. To help members understand the good faith estimates and price transparency for diagnostic medicine, the CAP created a toolkit to download and use in their practices. Specifically for pathologists, the good faith estimate must include expected charges for the items or services provided in conjunction with the primary item or service. The CAP had urged Congress to hold patients harmless from bills for out-of-network services provided at in-network hospitals or facilities and now engages with the administration on implementing the No Surprises Act.
The No Surprises Act included provisions intended to protect uninsured (or self-pay) individuals from unexpectedly high medical bills. When a physician/facility schedules an item or service (such as a medical device, a doctor’s visit, or a surgical procedure), it must determine the individual’s health insurance status. Suppose the patient has no coverage (uninsured) or does not intend to submit a claim to the plan/coverage (self-pay). In that case, the physician/facility must notify the patient of the good faith estimate of expected charges.
Specifically, a good faith estimate provided to uninsured (or self-pay) individuals must include an itemized list of all items or services that are reasonably expected to be furnished for that period of care, grouped by each provider or facility.
Check out the toolkit and look for additional resources.