Despite ongoing litigation over certain aspects of the federal surprise billing law, many of the patient protection components of the No Surprises Act still took effect in 2022. However, enforcement of a price transparency measure slated for Jan. 1, 2023, has been delayed indefinitely, giving physician practices more time to prepare.
The Centers for Medicare & Medicaid Services (CMS) announced that “pending future rulemaking,” it will extend enforcement of a requirement that physicians and facilities give uninsured or self-pay patients a good faith estimate (GFE) of what a service might cost when scheduling that service – even if multiple entities are involved, as with surgery, for instance. When this requirement goes into effect in the future, physicians and facilities must provide that estimate within three business days of scheduling the service.
CMS defines a GFE as “a notification that outlines an uninsured (or self-pay) individual’s expected charges for a scheduled or requested item or service.” Physicians and facilities defined as “convenors” – typically those scheduling the service – are responsible for putting together cost estimates from each “co-provider” or “co-facility” involved with providing the treatment – in other words, contacting each one for its portion of price information, compiling that information, and then sharing it with the patient.
Federal regulators said they “received comments and feedback indicating that compliance with this [convening provider] provision is likely not possible by Jan. 1, 2023, given the complexities involved with developing the technical infrastructure and business practices necessary for convening providers and facilities to exchange GFE data with co-providers and co-facilities. … Any rulemaking to fully implement the requirements ... will include a prospective applicability date that gives providers and facilities a reasonable amount of time to comply with any new requirements."
In a nationwide survey conducted by WEDI – a formal health information technology advisor to the secretary of Health and Human Services – 92% of small/medium/large clinics, health systems, hospitals, and other facilities that responded said it would be difficult or very difficult to collect GFE information from co-providers and/or co-facilities; 89% said it would be difficult or very difficult for the convening provider to identify all co-providers and/or co-facilities; and 76% said it would be difficult or very difficult to determine who the convening provider or facility is.
Texas Medical Association and American Medical Association leaders urge physicians to get educated now about the federal No Surprises Act. Find educational materials on TMA's surprise billing webpage.
Last Updated On
February 10, 2023
Originally Published On
December 13, 2022
Amy Lynn Sorrel
Associate Vice President, Editorial Strategy & Programming
Division of Communications and Marketing