On August 2, 2022, the Medical Group Management Association (MGMA) sent a letter to Xavier Becerra, Secretary of the Department of Health and Human Services (HHS) and Chiquita Brooks-LaSure, Administrator of the Centers for Medicare & Medicaid Services, requesting an extension before enforcement of any additional surprise billing requirements under the No Surprises Act.
Under the No Surprises Act, providers are prohibited from billing patients for more than in-network care costs. However, a recent survey found that 21% of adults are still receiving surprise medical bills from out-of-network providers at in-network facilities (either for themselves or a family member), and nearly 1/3 of patients surveyed said they (or a family member) received an unexpected bill for lab work collected at an in-network facility that was sent out-of-network.
MGMA notes that the No Surprises Act “established critical patient protections against balance billing and created new cost transparency tools to help patients be empowered to in the healthcare decision making process.” However, the group says that “while critical policies ensuring patients have access to the necessary and most accurate cost estimate information, these new requirements under the No Surprises Act created significant additional administrative burdens for group practices.” In particular, MGMA notes that the interim final rules that established the new requirements were published with “minimal time prior to the implementation date” and that tight turnaround time sowed confusion among many group practices.
Additionally, while HHS and CMS have provided some resources for group practices, the resources came after the new mandates took effect, and as such, the additional clarification caused duplicative work on behalf of some group practices as they had already rushed to interpret the requirements.
The letter referenced a survey taken during a MGMA member educational webinar, which found that 58.2% of respondents felt additional guidance related to state versus federal surprise billing requirements was necessary, 54.2% of respondents felt additional guidance related to the uninsured and self-pay GFE requirements was necessary; and 41.2% of respondents felt additional guidance related to the prohibition of balance billing was necessary.
MGMA called for a six month period after the publication of any final rule implementing requirements under the No Surprises Act prior to the enforcement date, to avoid any further confusion among group practices and to ensure that the policies are fully communicated and understood.
MGMA went a step further and noted that the convening and co-provider requirements related to the uninsured and self-pay GFE requirements are scheduled to take effect on January 1, 2023, and the administrative requirements and technical standards necessary to effectively implement those requirements are still not established. Therefore, they also request HHS and CMS leverage enforcement discretion and delay the implementation of those requirements until they can “fully be appropriately communicated with practices in a timely manner.” Referring back to the survey taken during the MGMA member educational webinar, 60.8% of respondents need additional guidance prior to implementation to appropriately apply the policy.