The 45 CFR 149.610 Compliance Folder (Chiropractic Edition)

This folder contains the mandatory documentation and staff implementation guides required for compliance with the Federal "No Surprises Act" (45 CFR 149.610).

These templates are designed specifically for Chiropractic offices to prevent the maximum civil monetary penalties ($10,000/violation) associated with non-compliance.

Included Files:

1. Staff Decision Matrix (PDF) A visual flowchart for the front desk. Used to determine if a patient is legally required to receive a Good Faith Estimate (GFE) based on their specific insurance status.

2. GFE Strategy Guide (PDF) Operational guidance on setting "Estimate Ranges." This document explains how to structure estimates to account for variable healing times without triggering a dispute.

3. Standard GFE Template (Word + Google Doc) The standardized form for patient issuance. Includes a backup link for cloud access.

4. Front Desk Scripting (PDF) Verbatim language for staff to use when presenting the form to patients. Focuses on explaining the document as a "Cost Protection" measure to avoid patient confusion.

5. Website Disclosure Text (TXT) The required legal text for your website.

• Instruction: Forward this file to your web developer, or create a new page on your site titled "Good Faith Estimate" and paste the text there.
• Requirement: This link must be visible on your homepage (footer).

6. Waiting Room Declaration Poster (JPG) Print-ready file for public display. Includes whitespace at the header for clinic branding/logo.

7. California State Supplement (PDF) differentiation fact sheet for CA providers (AB 72 vs. Federal Law).

Delivery: Instant Digital Download (ZIP Folder).