Organized medicine, including the Texas Medical Association, is engaging the Biden administration on health plans’ unfair business practices physicians sometimes encounter when receiving electronic payments.
TMA and many other state medical societies and national specialty organizations signed onto an American Medical Association letter that urges the administration to crack down on fees insurers charge when paying physicians by electronic funds transfer (EFT).
The missive to the Centers for Medicare & Medicaid Services (CMS) requests that the administration issue guidance that “affirms physicians’ right to choose and receive basic EFT payments without paying for additional services.”
An increasing number of physicians have reported “being forced to incur mandatory, percentage-based fees” on such transactions, the letter notes. In fact, in a recent Medical Group Management Association poll, 57% of medical practices reported that health plans, when paying the practice by EFT, charged fees the practice didn’t agree to. Of that group, 86% reported being charged either 2% or 3% of their total payment.
Usually, the fees are assessed by third-party vendors that health plans require physicians to contract with in order to receive EFT payments, the letter noted.
“While we recognize that some physicians may elect to receive supplementary services to the EFT standard for additional fees, these vendors do not offer physician practices the choice of electing basic EFT payments without charge,” AMA, TMA, and the other organizations wrote. “Consequently, physicians are left with no option but to ‘pay to get paid.’ This outrageous situation is analogous to an employee being required to enroll in a program that would deduct a percentage of each paycheck to receive direct deposit payments from an employer.”
There are potential downstream negative consequences for patient care as well, medicine warned.
“Physician practices that lose up to 5% of claims payments due to EFT fees are less able to invest in the additional staff, medical equipment, data analytics, and information technology that could improve care access and quality. In addition, physicians and their staff report significant administrative burdens when they attempt to disenroll in EFT fee-based programs. This represents valuable practice time and resources that would be much better spent on direct patient care.”
The letter says CMS has the authority, under law and regulation, to “act immediately” to protect physicians against such fees. It asks the agency to swiftly issue guidance that all health plans and their vendors must offer “at least one EFT standard transaction that does not require purchase of extra services for an additional fee.”
The guidance should also require “full transparency from health plans and their contracted vendors” in all communications regarding a medical practice’s EFT options, medicine urged, and CMS’ Division of National Standards should “appropriately enforce compliance with this guidance.”