MGMA asks feds for fair warning before additional surprise billing requirements are enforced

The Medical Group Management Association sent a letter to the U.S. Department of Health and Human Services urging it to provide at least six months’ notice before enforcing any additional surprise billing requirements as part of the No Surprises Act.

The act created cost transparency tools to help patients know exactly how much their care will cost, and on January 1, several provisions took effect, including federal protections against balance billing, uninsured and self-pay good faith estimate requirements, continuity of care protections, and provider directory requirements.

“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,” the MGMA letter reads in part. “The interim final rules establishing these new requirements were published with minimal time prior to the implementation date; such a tight turnaround time created significant confusion among many group practices. And while HHS and CMS have provided several detailed resources for group practices, the additional clarifying information came after the new mandates took effect.”

The MGMA noted that 58.2% of its members want additional guidance related to state versus federal surprise billing requirements, 54.2% want additional guidance related to the uninsured and self-pay GFE requirements, and 41.2% of respondents indicated additional guidance related to the prohibition on balance billing is necessary.

“To avoid further confusion among group practices and ensure such policies are fully communicated and understood, MGMA recommends HHS and CMS provide at least six months after the publication of any final rule implementing requirements under the No Surprises Act prior to the enforcement date,” the MGMA letter reads.

Additionally, MGMA voiced concern about the convening and co-provider requirements related to uninsured and self-pay GFE requirements slated to take effect Jan. 1, 2023, should not be enforced. “The administrative requirements and technical standards necessary to effectively implement these requirements have not yet been established. As such, MGMA believes HHS and CMS should similarly leverage enforcement discretion and delay the implementation until the requirements can fully be appropriately communicated with practices in a timely manner. Among MGMA’s membership, the convening and co-provider requirements cause significant confusion, 60.8% of members require additional guidance from the department prior to January 1, 2023, in order to appropriately implement the policy. These new mandates require significant time to understand and implement.”

The MGMA noted that in the current environment of staffing shortages, inflation, and reductions in Medicare payments, now is not the time for the quick implementation of major policies.