Practices Not Ready to Implement NSA’s Good Faith Estimates

Physician practices are struggling to comply with the No Surprises Act’s good faith estimate requirements, which went into effect on Jan. 1, 2022. The new federal law requires all providers to give uninsured and self-pay patients, both orally and in writing, a cost estimate upon request or at the time of scheduling.

Lawmakers designed the good faith estimate requirements to protect patients from unexpected medical bills, known as surprise bills. The requirements do this by delivering healthcare price transparency to those without insurance or who choose not to use their plan’s coverage.

However, medical practices are having trouble understanding the new good faith estimate requirements and implementing workflows to comply with the No Surprises Act, the Medical Group Management Association (MGMA) says. MGMA called on HHS and CMS to delay enforcement of the uninsured and self-pay good faith estimate requirements until practices have had time to digest the rules and execute a strategy.

“While MGMA supports the spirit of the transparency provisions in the No Surprises Act and has continued to partner with HHS, CMS, and other Departments to implement critical patient protections, the administrative burden during the continuing COVID-19 pandemic and Omicron surge places unnecessary pressure on group practices to implement cost estimate mechanisms to meet the prescriptive requirements set forth by the Department,” Anders Gilberg, MGA, senior vice president of government affairs at MGMA, wrote in a Jan. 26th letter to federal healthcare leaders.

An MGMA survey cited in the letter found that 90 percent of medical practices have experienced increased administrative burden as a result of the good faith estimate requirements even though it has barely been a full month since they went into effect. Primarily, the practices struggled with finding the staff to handle good faith estimates, the survey indicated.

The Omicron surge has exacerbated staffing shortages for medical practices, leaving many offices without the bandwidth to turn around good faith estimates per federal law.

MGMA explained that 41 percent of group practices participating in the survey said that patient appointments are usually schedule three to ten business days prior to service. The No Surprises Act requires providers to deliver good faith estimates to uninsured and self-pay patients within one business day of scheduling.

“However, with the increased administrative burden and serious staffing shortages, practices will not have the capacity to provide [good faith estimates] within one business day and will instead be potentially forced to schedule services much farther in advance to comply with the strict timing requirements,” Gilberg stated.

HHS and CMS should provide more guidance on good faith estimate compliance and implementation, MGMA suggested. In the meantime, the government should delay enforcement of the requirements to “provide practices with necessary time to engage with the agency and fully understand the new requirements without having to duplicate efforts as new information becomes available and requirements are made clear.”

CMS has released 11 documents to help providers comply with the good faith estimate requirements. The federal agency released late last year several templates providers and facilities can use to deliver the cost estimates to self-pay and uninsured individuals.

MGMA stated that practices still have “many questions” about the requirements despite the templates and the challenge of implementation has more to do with establishing workflow and providing training to staff on the new requirements. This also has to happen as the same time practices comply with the good faith estimate requirements for insured patients.

CMS has not provided a public comment on the letter. However, the agency said in a recent FAQ document that the administrative burden associated with providing good faith estimates to uninsured or self-pay patients is “is likely to vary based on the number of uninsured (or self-pay) individuals served by a particular provider or facility, and variations in practice patterns, such as the types of items or services provided.”