MGMA Requests Longer Notice Before Surprise Billing Enforcement

The Medical Group Management Association (MGMA) has asked CMS and HHS to provide medical group practices with at least six months’ notice before enforcing any additional surprise billing requirements under the No Surprises Act.

In a letter addressed to HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks La-Sure, MGMA acknowledged that while the No Surprises Act policies help protect patients from surprise billing, the requirements have created significant administrative burden for medical group practices.

The group wrote that the interim final rules establishing the surprise billing requirements were published with minimal time before the implementation data. Medical practices had to move quickly to interpret the requirements and meet the standards, which led to considerable confusion, MGMA said.

HHS and CMS have since provided more detail for group practices, but the information came after the mandates went into effect, causing practices to perform duplicative tasks to update processes and comply with the policies.

Several provisions of the No Surprises Act took effect on January 1, 2022, including federal protections against balance billing, continuity of care protections, provider directory requirements, and uninsured and self-pay good faith estimate (GFE) requirements.

Yet, many MGMA members have stated that they need additional guidance to fully understand the policies.

During a recent MGMA member educational webinar, 58 percent of attendants said they needed additional guidance related to state versus federal surprise billing requirements. Nearly 55 percent of members wanted additional information related to the uninsured and self-pay GFE requirement and 41 percent indicated that more guidance on the prohibition on balance billing was necessary.

HHS and CMS have announced that they will publish additional rulemaking related to the advanced explanation of benefits (AEOB) requirements, continuity of care protections, and provider directory requirements.

“To avoid further confusion among group practices and ensure such policies are fully communicated and understood, MGMA recommends HHS and CMS provide at least six months after the publication of any final rule implementing requirements under the No Surprises Act prior to the enforcement date,” the letter stated.

MGMA also urged HHS and CMS to use enforcement discretion for the convening and co-provider requirements related to the GFE requirements set to take effect on January 1, 2023.

HHS and CMS have not yet established the administrative requirements and technical standards needed to implement these requirements. Therefore, MGMA has requested that the agencies delay the implementation until the requirements can be communicated to practices promptly.

Six in ten MGMA members said they require additional guidance before January 1, 2023 to properly implement the policy, the letter noted.

Understanding and implementing the surprise billing mandates with an inadequate timeline creates additional struggles for group practices that are already facing staffing shortages, inflation, and Medicare payment cuts, MGMA wrote.

In addition, additional administrative and support staff funding is usually the first to be reduced when practices experience financial challenges.

“The current environment of the healthcare industry does not lend itself to quick implementation of major policies,” the letter concluded.

MGMA recently called on CMS to update the federal independent dispute resolution (IDR) portal to streamline the arbitration process that determines an out-of-network payment rate for a surprise medical bill.

The group said that improving communication processes and providing the option to edit existing applications would help practices complete the IDR initiation while balancing staffing shortages, administrative costs, and policy changes.

Other trade organizations, including the American Hospital Association (AHA) and the American Medical Group Association (AMGA), have raised concerns about surprise billing requirements, such as the GFE policy.

The groups stated that the policy creates administrative burden for healthcare practices and negatively impacts provider workflows.