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5 Ways to Reduce No Surprises Act Burdens

Analysis  |  By Amanda Norris  
   November 17, 2022

The MGMA recently detailed five ways the government can help alleviate burdens from certain requirements under the No Surprises Act.

The Medical Group Management Association (MGMA) recently provided written comments to the HHS, the Department of the Treasury, and the Department of Labor regarding rulemaking for the advanced explanation of benefits (AEOB) and good faith estimate (GFE) requirements of the No Surprises Act.

The No Surprises Act, which became effective January 1, contains provisions that protect patients from surprise medical billing and out-of-network emergency care costs not reimbursed by insurance. And as we have seen from other letters penned to the departments, many medical associations are finding the AEOB and GFE requirements to be the most burdensome right now.

According to the MGMA, to address ongoing concerns regarding the GFE and AEOB requirements, the departments should:

  1. Not enforce AEOB requirements until there are workable solutions that are developed, tested, and implemented.
    • The departments stated they would delay implementation of the AEOB policies until rulemaking has occurred, but the MGMA says this is not enough time for the industry to roll out and deploy the necessary standards needed to implement these requirements.
  2. Allow for patients to opt-in to receiving AEOBs and GFEs.
    • At a minimum, the MGMA says the departments should allow for practices to apply for a hardship exemption, which would give them additional time to apply.
  3. Not yet rely on new, fast healthcare interoperability resources-based standards to implement AEOB requirements.
    • Whichever standard the departments support should take into consideration medical practices of all sizes and regions, as well as those who are under-resourced, the MGMA said. In addition, the MGMA says a standard must be developed, tested, and readily available to medical groups before the AEOB requirements are implemented and enforced.
  4. Extend the enforcement discretion for the convening provider/facility and co-provider/facility provisions for GFEs.
    • The MGMA says enforcement discretion should continue until appropriate standards have been developed, tested, and implemented by group practices.
  5. Continue soliciting input and working with stakeholders, such as medical groups, to implement workable policies that empower patients, but not at the expense of delivering care.

Amanda Norris is the Director of Content for HealthLeaders.

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