Physician group asks for extension on surprise billing regulations
The Medical Group Management Association (MGMA) has asked the Department of Human Health and Service (HHS) to wait at least six months before enforcing rules on price transparency.
The association, which has 15,000 medical groups comprising 350,000 physicians among its membership ranks, wrote to HHS Secretary Xavier Becerra and Administrator of the Centers for Medicare and Medicaid Services (CMS) Chiquita Brooks-LaSure to urge regulators to hold off on enforcing the No Surprises Act. As of Jan. 1, 2022, consumers gained more protections from surprise billing practices, including receiving surprise bills for out-of-network care not typically covered by their health plans.
While MGMA recognized that the No Surprises Act “established critical patient protections against balance billing and created new cost transparency tools to help patients,” the association argued the new requirements for 2022 also carried “ significant additional administrative burdens for group practices.” MGMA stated in its letter that medical practices have had minimal time prior to the implementation date, and the tight turnaround has created confusion at some practices.
The letter, dated Aug. 2, comes as just 16% of hospitals were revealed to be complying with federal rules to post the prices of some 300 medical procedures online, where the public can easily access them to see how much they may owe for receiving care. Surprise billing has been an issue for years, with patients grappling with huge costs for bills they didn’t know were coming or for care costs they didn’t know they were on the hook to pay. In some cases, patients have received bills charging hundreds of thousands of dollars weeks or months after receiving care.
In 2022, federal protections against balance billing, uninsured and self-pay good faith estimate (GFE) requirements, continuity of care protection and provider directory requirements went into effect, impacting medical groups. MGMA noted that some clarifying resources have been made available to group practices. However, these were published and distributed after the rules had already gone into effect, leading to duplicative work to update processes to be in compliance, they wrote in the letter.
Plus, even with the clarifications from regulators, many group practices are still struggling with the new requirements. In a recent MGMA member survey, respondents said they needed more guidance on state vs. federal surprise billing requirements (58.2%), guidance related to the uninsured and self-pay GFE requirements (54.2%) and guidance on balance billing (41.2%). As such, enforcement on these requirements should be delayed for at least six months, MGMA said. In addition, group practices are grappling with other, ongoing challenges, including staffing shortages, payment cuts and record inflation.
“With continued uncertainty, layering new requirements will only create additional burdens and uncertainties for both providers and patients,” MGMA wrote.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."