MGMA Argues for Advanced Notice of No Surprises Act Enforcement


The group is asking CMS to provide an appropriate timeline for layering new surprise billing requirements, which have created administrative burden for providers.

The Medical Group Management Association (MGMA) is pushing HHS and CMS to give providers at least six months’ notice before enforcing any additional requirements for the No Surprises Act.

Several aspects of the surprise billing mandate went into effect on January 1 of this year, including federal protections against balance billing, uninsured and self-pay good faith estimate (GFE) requirements, continuity of care protections, and provider directory requirements. While the policies have been beneficial for patients, MGMA says the requirements have created administrative burden for providers as the interim final rules were published with minimal time before implementation.

With HHS and CMS indicating additional rulemaking will be published related to the advanced explanation of benefits (AEOB) requirements, continuity of care protections, and provider directory requirements, MGMA recommends an appropriate timeline for implementation and enforcement.

“MGMA recognizes the statutory requirements and the urgency to prevent any further delays in patient access to this information, however, we believe that existing cost estimate information provided by both insurers and practices can adequately ensure patients are aware of cost estimate information prior to the implementation of the AEOB requirements,” the group writes in a letter to HHS secretary Xavier Becerra and CMS administrator Chiquita Brooks-LaSure.

“Similarly, group practices have been complying with the continuity of care protections and provider directory requirements in a good faith, reasonable effort according to the statute since January 1, 2022.”

MGMA cites a recent member educational webinar in which 58.2% of respondents said additional guidance on state vs. federal surprise billing requirements is necessary, while 54.2% wanted additional guidance on the uninsured and self-pay GFE requirements, and 41.2% wanted additional guidance on the prohibition on balance billing.

Additionally, MGMA is asking HHS and CMS to delay the implementation of the convening and co-provider requirements related to the uninsured and self-pay GFE requirements, set to take effect on January 1, 2023.

Over 60% of MGMA members need more guidance on the convening and co-provider requirements before they go into effect to properly implement the policy, the group states.

“These new mandates require significant time to understand and implement,” MGMA writes. “Group practices are currently facing significant staffing shortages, record-breaking inflation, and significant reductions in Medicare payment.”

Jay Asser is an associate editor for HealthLeaders.



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