Good faith estimate tool terms.

These Good Faith Estimate Tool Terms and Disclaimer (“GFE Terms”) govern use of the Good Faith Estimate generator and any related estimate, notice, template, checklist, calculator, or educational resource made available through HandshakeMD, operated by shrinkMD Publishing LLC (“Company,” “we,” “us,” or “our”).

By using the tool, you agree to these GFE Terms, the Terms of Use, the Privacy Policy, and the Consumer Health Data Privacy Policy.

1Purpose of the tool

The Good Faith Estimate tool is provided as a free informational and administrative resource to help healthcare professionals prepare a written estimate of expected charges.

The tool is intended to assist with document preparation. It is not a substitute for legal advice, compliance advice, billing advice, or independent review of applicable federal or state requirements.

2The Company is not the treating provider

The Company is not the healthcare provider or facility issuing the estimate.

The professional or facility using the tool is solely responsible for:

• determining whether a Good Faith Estimate is required;
• determining when it must be provided;
• determining which items and services must be included;
• ensuring that all charges are accurate and reasonably expected;
• identifying the correct provider or facility;
• delivering the estimate to the patient in the required manner;
• updating the estimate when legally required;
• maintaining any required records; and
• complying with applicable federal and state law.

3When a Good Faith Estimate may be required

Under current federal guidance, healthcare providers and facilities generally must provide uninsured or self pay individuals with a Good Faith Estimate of expected charges when the individual requests one, or when qualifying care is scheduled sufficiently in advance. CMS currently states that patients who schedule care at least 3 business days in advance generally should receive an estimate, and that a patient may also request one before scheduling.

Current CMS timing guidance generally provides:

• if care is scheduled 0 to 2 business days in advance, the federal requirement generally does not require an estimate before the visit;
• if care is scheduled 3 to 9 business days in advance, the estimate generally must be provided within 1 business day after scheduling;
• if care is scheduled 10 or more business days in advance, the estimate generally must be provided within 3 business days after scheduling; and
• if an uninsured or self pay individual requests an estimate before scheduling, the estimate generally must be provided within 3 business days after the request.

Emergency care is treated differently. CMS states that the Good Faith Estimate requirement does not apply to emergency services, which are addressed by other parts of the No Surprises Act.

These rules can change, and exceptions or additional requirements may apply. The figures above are stated as of the effective date of this document. CMS publishes the current requirements at cms.gov/nosurprises, and that is the source to check rather than this page.

4Uninsured and self pay individuals

For federal Good Faith Estimate purposes, an uninsured or self pay individual generally includes someone who:

• does not have health coverage for the applicable item or service; or
• has health coverage but does not intend to have a claim submitted to that coverage for the item or service.

Users should not assume that every cash pay encounter is identical for purposes of federal or state law.

5The tool does not determine legal applicability

The tool does not determine whether:

• a patient legally qualifies as uninsured or self pay;
• a Good Faith Estimate is required;
• a particular service is subject to the federal requirement;
• an exception applies;
• a state law imposes additional obligations;
• an estimate must include another provider or facility;
• an updated estimate is required; or
• a dispute resolution process is available.

Users are responsible for making those determinations independently.

6Accuracy of information

The tool generates an estimate based entirely on information entered by the user.

The Company does not verify:

• patient information;
• service descriptions;
• CPT, HCPCS, or other billing codes;
• diagnosis codes;
• provider information;
• dates of service;
• expected quantities;
• fees;
• facility charges;
• related services; or
• other information entered into the tool.

The Company could not verify any of it in any event, because none of what you type into the tool is transmitted to us. See section 11.

The user is solely responsible for reviewing the completed estimate before providing it to a patient.

7Expected charges are estimates

A Good Faith Estimate is an estimate of reasonably expected charges, not a guarantee of the final amount billed.

Actual charges may differ because of:

• additional services;
• changed clinical circumstances;
• revised treatment plans;
• separately scheduled services;
• services provided by another professional or facility;
• complications;
• changes in coding; or
• other circumstances not reasonably anticipated when the estimate was prepared.

CMS notes that a Good Faith Estimate may not include separately scheduled services, services furnished by other providers or facilities, or additional items and services that were not anticipated before care was provided.

8Patient provider dispute resolution

Under the federal patient provider dispute resolution process, an uninsured or self pay patient may generally be eligible to dispute a bill when the billed charges from a provider are at least $400 greater than the expected charges shown on that provider's Good Faith Estimate.

The deadline for starting a dispute, and any administrative fee for using the process, are set by CMS and have changed over time. Current figures are published at cms.gov/nosurprises and at CMS Medical Bill Rights.

The tool does not determine whether a patient qualifies for dispute resolution, and does not initiate or administer that process.

9Required patient notice

Federal rules also require applicable healthcare providers and facilities to make notice of the right to receive a Good Faith Estimate available to uninsured or self pay individuals. CMS provides a model notice and states that the notice should be clearly displayed at applicable locations and be easy to find on the provider or facility website.

The Platform is not the provider or facility responsible for satisfying that notice requirement. Producing an estimate with this tool does not satisfy it, and does not evidence that it has been satisfied.

10Federal and state law

The No Surprises Act establishes federal requirements, but state laws may impose:

• additional estimate requirements;
• different timing requirements;
• billing disclosure obligations;
• price transparency obligations;
• consent requirements; or
• other patient notice obligations.

Use of this tool does not establish compliance with any state specific requirement.

Users should obtain legal or compliance advice appropriate to their jurisdiction and practice.

11Local browser processing

The Good Faith Estimate generator on this Platform is processed locally in your browser. Everything you type stays on your device, nothing is transmitted to the Company, and no copy of the estimate is created on our systems. An automated check loads the tool page, exercises the form, and fails our build if any request leaves our own domain, if a cookie is set, or if browser storage is used.

Where a tool is expressly identified as being processed locally in the user's browser:

• information entered into the tool is intended to remain on the user's device;
• the Company does not receive, store, retain, or transmit that information;
• the Company does not maintain a copy of the generated estimate unless a separate feature expressly says otherwise; and
• the user is responsible for the security of the device, browser, network, extensions, and local environment used to prepare the estimate.

Local processing moves the risk rather than removing it. A shared computer, an unlocked screen, a synced browser profile, or a browser extension that reads page contents can all expose what you type. Do not use the tool in an environment that is inappropriate for the information you intend to enter.

12No HIPAA representation

The availability of the tool does not mean that the Platform is functioning as a HIPAA covered entity, business associate, electronic health record, or secure clinical communication platform.

If patient related information is processed locally without being transmitted to the Company, that local processing does not itself mean the Company receives or maintains protected health information.

Healthcare professionals remain responsible for their own HIPAA and privacy obligations.

13No storage or recovery

Because the tool is locally processed and saves nothing to Company systems, the Company cannot:

• recover a lost estimate;
• retrieve patient information;
• restore deleted entries;
• produce a prior estimate; or
• provide a copy later.

This is the trade for the tool not holding patient information. Print or save each completed estimate when you make it, and retain it in accordance with your own legal, compliance, and recordkeeping obligations. Closing the tab loses the work.

14No legal or compliance advice

The tool, explanatory text, sample language, and generated output do not constitute:

• legal advice;
• compliance advice;
• billing advice;
• tax advice;
• insurance advice; or
• a legal opinion.

Use of the tool does not create an attorney client, consultant client, or healthcare provider relationship with the Company.

15No warranty of compliance

The Company does not warrant or guarantee that:

• the tool contains every legally required field;
• the generated estimate satisfies every federal or state requirement;
• the estimate will prevent a complaint or dispute;
• the estimate will be accepted by a regulator;
• a patient will be ineligible to dispute a bill;
• the tool will remain current with every regulatory change; or
• use of the tool will establish compliance.

The user is responsible for reviewing all generated documents before use.

16No substitute for official CMS materials

Users should consult current CMS materials and applicable regulations when compliance is important.

The Platform links to official CMS resources for convenience, including cms.gov/nosurprises and CMS Medical Bill Rights. Those are the authority. This page is not.

17Changes to the tool or the law

Federal and state requirements may change.

We may modify the tool, its fields, instructions, or legal language from time to time.

Users should not rely on a previously generated estimate template as proof that current legal requirements remain unchanged. An estimate you produced last year is a record of what you told a patient, not evidence of what the law requires today.

18Limitation of liability

The limitation of liability provisions in the Terms of Use apply to this tool and are incorporated by reference.

To the maximum extent permitted by law, the Company is not responsible for losses, penalties, claims, disputes, billing adjustments, reimbursement consequences, or other damages resulting from:

• inaccurate information entered by the user;
• failure to provide a required estimate;
• late delivery;
• omitted services or charges;
• incorrect coding;
• reliance on outdated law;
• failure to comply with state requirements; or
• misuse of the tool.

19Contact

Questions about the tool may be directed to:

shrinkMD Publishing LLC
Operator of HandshakeMD
Email: [email protected]
Northwest Registered Agent LLC, 7901 4th St N Ste 300, St. Petersburg, FL 33702