AMGA Asks CMS to Amend Good Faith Estimate Policy, Guidance

The American Medical Group Association (AMGA) has asked CMS to amend aspects of the good faith estimate (GFE) requirements that contain unclear guidance, exacerbate staffing constraints, and create cost barriers for providers.

In a letter to CMS Administrator Chiquita Brooks-LaSure, AMGA supported efforts to increase price transparency and improve patient care but noted that the current GFE policy under the No Surprises Act negatively impacts provider workflows and operations.

The good faith estimates policy went into effect on January 1, 2022, and requires providers to give uninsured and self-pay patients an estimate of expected charges for services upon scheduling visits.

Certain aspects of the policy have created challenges for providers regarding scheduling, coordinating, and delivering care to patients, AMGA said.

The letter urged CMS and HHS to exercise enforcement discretion as providers manage these challenges.

Specifically, AMGA voiced concern about the unclear guidance in the policy that outlines when a GFE is required.

Patient guidance states that if patients schedule services at least 10 business days before receiving it, or if they request cost information about a service, the provider must give them a good faith estimate no later than three business days after the scheduling or request. But this guidance does not account for requests that come less than three business days in advance.

Meanwhile, provider guidance states that GFEs should include charges for services that are “reasonably expected” to be provided as part of the primary reason for visiting. However, AMGA pointed out that anticipating reasonably expected services and producing GFEs for each service requires significant coordination between non-clinical staff and practitioners.

“With unclear guidelines, our member groups struggle to implement an efficient workflow to comply with the GFE requirements,” AMGA wrote.

The GFE policy requirements have also exacerbated staffing challenges for healthcare practices, the letter noted.

“Current GFE requirements impose additional tasks to an already strained healthcare workforce, which further risks impairing patient access to timely and necessary medical care,” the letter stated. “Staff fulfilling GFE responsibilities need to be knowledgeable about multiple aspects of healthcare (e.g., coding, facilities, providers, schedulers, and fee schedules) and need to effectively coordinate with multiple provider departments.”

The policy has required providers to shift staff members from other critical responsibilities to GFE management. This could worsen staffing shortages and result in care delays for patients, the letter stated.

Lastly, AMGA voiced concern about the cost and infrastructure investments needed to comply with the GFE requirements. According to the letter, providers have had to make infrastructural changes to provide good faith estimates to uninsured and self-pay patients.

One practice has allocated more than 40 staff members, each working around eight hours per week, to develop a system that will provide GFEs, AMGA reported. Other practices have reported expenses from mailing hard copies of GFEs and storing the estimates in their EHRs.

Providing accurate estimates also requires significant time and resources from healthcare practices, AMGA said. Additionally, inaccurate estimates may lead to more challenges, such as costly patient-provider dispute resolution processes and hampered patient-provider relationships.

“AMGA recommends that CMS work with stakeholders to determine a process in which GFEs are beneficial for patients while not causing additional administrative burdens to providers,” the letter read.

In addition, the organization has requested to meet with CMS officials to discuss the barriers to complying with the good faith estimate policy and potential solutions to these obstacles.

AMGA is not the first organization to raise concerns about the good faith estimate requirements.

In March 2022, the American Hospital Association (AHA) asked CMS to adjust the GFE policy, asserting that the requirements create administrative burden and operational inefficiencies for hospitals and health systems.

The Workgroup for Electronic Data Interchange (WEDI) also highlighted issues with the policy. The group urged CMS to expand the timeframe for good faith estimates and amend the price threshold for the patient-provider dispute resolution process.