MGMA Requests Modifications of Good Faith Estimate Requirements

The Medical Group Management Association (MGMA) has asked HHS, the Department of Labor, and the Department of the Treasury (the Departments) to modify the good faith estimate (GFE) and advanced explanation of benefits (AEOB) requirements of the No Surprises Act to improve provider and patient experiences.

MGMA submitted comments in response to a request for information from the Departments about rulemaking for the GFE and AEOB requirements. The organization said it supports the goals of the No Surprises Act but has some concerns about how certain provisions will be implemented.

The GFE policy requires providers to give uninsured and self-pay patients an estimate of expected charges for services upon scheduling visits. After insurers receive a GFE from providers, they must provide patients with an AEOB for the services included.

MGMA cited data showing that 82 percent of medical groups reported that the GFE requirements had increased administrative burden. In addition, 89 percent of medical groups said their practice is concerned with the additional burden related to implementing AEOB requirements.

The Departments have said they plan to delay the AEOB policy implementation until rulemaking has occurred. However, MGMA noted that this is not enough time for the industry to deploy the necessary standards to implement the requirements.

MGMA said that workable solutions must be developed, tested, and implemented before the Departments enforce the policies.

The organization has also asked for an exception for cases when patients decide to forgo receiving an AEOB or GFE, as receiving multiple AEOBs can confuse patients. Alternatively, practices should be able to request a hardship exemption to allow for more time to comply with the regulations.

MGMA urged the Departments not to rely on FHIR-based standards to implement AEOB requirements, as they are not an appropriate option for medical practices of all sizes and regions.

“Additionally, the Departments should require insurers to send the AEOB to both the patients and the medical groups that provided the GFE to the insurers,” the letter stated. “If the intent of the AEOB is to provide more transparency around the costs and treatment plans, this information should be communicated to the practices as well, so they can assist patients.”

The letter also raised concerns about the GFE convening and co-provider requirements. Medical groups have reported requiring additional guidance about the requirements prior to its January 1, 2023 effective date.

MGMA requested that the Departments exercise enforcement discretion for the convening and co-provider requirements until they issue more guidance and develop a uniform standard.

In addition, the Departments should leverage existing provider and health plan workflows and technologies to support creating accurate AOEBs for patients. The Departments should also reject any standard process requiring billing providers to consolidate cost data into a single GFE, MGMA said.

In August, MGMA penned a letter to HHS and CMS asking the agencies to provide medical group practices with at least six months’ notice before enforcing any additional surprise billing requirements under the No Surprises Act.

Specifically, the organization referenced the GFE requirement, continuity of care protections, federal protections against balance billing, and provider directory requirements.

Earlier this year, the American Medical Group Association (AMGA) also voiced concerns about the GFE requirements, saying that the policy included unclear guidance about when a GFE is necessary and that the regulation exacerbated staffing shortages.