Federal regulators are not going to enforce a looming 2023 requirement for providers to include co-provider and co-facility charges in a good faith cost estimate to uninsured and self-pay patients.
The Centers for Medicare & Medicaid Services (CMS) released an FAQ document Friday on the new requirements set to go into effect Jan. 1. CMS said that it wants to extend enforcement discretion pending future rulemaking.
Provider groups have been hoping CMS would offer leeway on the requirement until standards have been developed and tested. They have also been worried that providers would not be ready to set up the system and technical infrastructure to share the needed information to offer the estimates.
“By extending this exercise of enforcement discretion, [the Department of Health and Human Services (HHS)] aims to promote further interoperability across the healthcare industry,” the FAQ said.
The No Surprises Act banned surprise medical bills and required providers to offer good faith estimates to uninsured or self-pay patients of the charges they can expect for visits, tests and other items or services. The estimate requirement went into effect in January of this year.
The law also called for the estimates to include the potential charges that may stem from a co-provider or co-facility starting on Jan. 1.
But provider groups have been worried about the implementation of the estimate requirements. The Medical Group Management Association (MGMA) conducted a survey of group practices back in January, with 90% of respondents saying the new estimate requirement increased administrative burden. MGMA has called for HHS to enable practices to apply for a hardship exemption to the estimate requirement.
“Almost a year after the [good faith estimate] requirements went into effect, medical groups are still struggling to establish workflows to transmit this information to patients, due to the prescriptive timelines and lack of available staff to work on them,” the group wrote in comments to HHS on the estimate requirements.
CMS wrote in the FAQ that stakeholders have wanted a delay in enforcing the requirements until the federal government established a standard technology to automate the creation of an estimate.
The agency wrote that Health Level 7 and Fast Healthcare Interoperability Resources (FHIR) standards hold "potential for supporting interoperability and enabling new entrants and competition throughout the healthcare industry.”
The good faith estimates were one part of the No Surprises Act, which banned surprise medical bills. The law also set up an arbitration process for payers and providers to settle out-of-network charge disputes. That process is still under scrutiny as providers have sued over HHS’ implementation of the law.