Fed Advisors Want Physician Input on Federal Surprise Billing Provision
By Joey Berlin

A workgroup that advises the federal government on health information technology matters is asking for physicians’ input on an important, but unrefined, provision of the federal No Surprises Act that isn’t yet being enforced. It’s a piece of the law that the Texas Medical Association fears might create more administrative burden for physicians.

The Workgroup for Electronic Data Interchange (WEDI) is surveying physician practices, hospitals, and other practitioners on the No Surprises Act’s “convening provider/facility” requirement, scheduled to start next year. The short survey aims to “understand the feasibility and challenges associated with the convening provider/facility process.”

The sweeping surprise-billing law, passed in 2020, requires physicians to provide a “good faith estimate” (GFE) of the costs of a medical service to uninsured, commercially insured, and self-pay patients. But if the service requires participation from multiple facilities or practitioners, a single “convening provider or facility” must take responsibility for:

  • Contacting all of the practitioners or facilities that could be involved in the service;
  • Receiving and compiling all the information on each GFE for the service; and
  • Giving all the GFE information to the patient.

However, questions abound about how that will work – because there’s no standardized process of exchanging those data between physicians. Even though the No Surprises Act is already in effect, the government is holding off on enforcement of the “convening provider” piece of the law until Jan. 1, 2023, for uninsured and self-pay patients. (No compliance date has been released yet for enforcing it for commercially insured patients.)

TMA and others remain concerned that with no standardized process in place, the “convening provider” role may fall to primary care and other physicians. And WEDI says its own No Surprises Act Task Group has “significant concerns regarding how the convenor requirement will work in the ‘real world’ of health care.”

WEDI is a formal advisor to the secretary of the U.S. Department of Health and Human Services, and says it anticipates using the survey results to craft a letter to the secretary with recommendations on the requirement.

The survey is open until May 27.

Last Updated On

May 18, 2022

Originally Published On

May 18, 2022

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Joey Berlin

Managing Editor

(512) 370-1393

Joey Berlin is managing editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area. He lives in Austin.

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