Physician practices seek more time to comply with No Surprises rules

Dive Brief:

• The Medical Group Management Association, which represents physician practices, is urging the HHS and the CMS to delay enforcing certain requirements of the No Surprises Act to allow providers time to understand and implement the mandates.
• In a letter to HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks La-Sure, MGMA asked that medical group practices be given six months’ notice before enforcement of additional surprise billing requirements.
• The provider group requested the enforcement delay following publication of more anticipated rulemaking including an advanced explanation of benefits, continuity of care protections and provider directory requirements.

Dive Insight:

Elements of the No Surprises Act went into effect in January, aimed at protecting patients from surprise medical bills by out-of-network providers. Among the statute’s provisions, providers are prohibited from billing patients for more than in-network care costs.

In practice, a large number of patients are still getting surprise bills, according to a survey conducted in June. One in five Americans reported receiving a surprise medical bill from an out-of-network provider at an in-network facility, and nearly a third said they got an unexpected bill for lab work collected at an in-network facility that was sent out-of-network.

CMS has delayed enforcement of the “convening provider” provision of the law through the end of the year due to time it will take for providers to comply with the requirement. The provision asks providers to anticipate additional care a patient may require from other physicians to create a good faith cost estimate.

MGMA said the No Surprises Act establishes critical patient protections and new cost transparency tools to help patients in the healthcare decision making process. But its members need additional guidance to fully understand the new mandates, the group asserted. For example, convening provider and co-provider requirements of the law are causing significant confusion among a majority of members, MGMA said.

Physician practices are also facing significant staffing shortages that make it difficult to quickly implement major policies, the group said in its letter.

The group said existing cost estimate information provided by both insurers and practices can adequately ensure patients are aware of cost estimates before implementation of the No Surprises Act’s advanced explanation of benefits requirement. Physician practices have been complying with continuity of care protections and provider directory requirements in a good faith effort under the statute since January, MGMA said.