Skip to main content

No Surprises Act Convening Provider Requirements Create Burden

Analysis  |  By Jay Asser  
   June 17, 2022

A survey reveals more than 80% of providers support delaying the requirement until there is a standardized data exchange process.

The convening provider requirements in the No Surprises Act pose challenges for providers, who would rather delay the obligation until data exchange standards are in place, according to a survey by the Workgroup for Electronic Data Interchange (WEDI).

Under the No Surprises Act, a convening provider or facility is responsible for providing a good faith estimate (GFE) to the uninsured patient, which includes contacting all other providers or facilities that may be involved with the patient's service to obtain a GFE for their portion.

However, there is currently no standardized data exchange process between the convening provider and co-providers, with respondents in the WEDI survey saying that absence creates significant burden on providers and facilities.

Over 80% of providers surveyed (83.1%) say they are somewhat or strongly in support of the government delaying the requirement for convening providers/facilities to obtain a GFE from any co-provider/facility until there is a standardized data exchange process in place. Only 7% are somewhat or strongly opposed, while 4.4% are neutral.

"While the No Surprises Act includes much needed consumer protections against catastrophic 'surprise' bills, it also includes challenging data exchange provisions such as the convening provider/facility requirement," stated Charles Stellar, WEDI president and CEO. "Even though the government plans to end enforcement discretion for self-pay patients at the end of this year, currently there is no standard format or established workflow to transmit data to or from the convenor."

The survey was conducted in May and received a total of 273 responses from small providers/clinics (39.6%), large provider clinics (11.5%), health systems (10.4%), medium sized clinics (8.5%), hospitals (2.2%), and other provider types.

Respondents gauge the difficulties of following the convening provider requirements, with 65.8% saying it would be very difficult or difficult for providers and facilities to determine who should be the convening provider. Meanwhile, 11.7% indicate it would be easy or very easy.

An overwhelming 89.3% say it would be very difficult or difficult for the convening provider to identify all appropriate co-providers for the specific medical service, with only 4.8% believing it would be easy or very easy.

An even stronger majority (91.5%) say it would be very difficult or difficult for convening providers to collect GFEs from co-providers for the specific medical service, while just 1.1% indicate it would be easy or very easy.

Finally, 89% state it would be very difficult or difficult for the convening provider to complete the GFE process for a specific medical service and provide it to the patient within the required three business days of being requested or the service being scheduled. Conversely, 2.6% say it would be easy or very easy.

"The survey results suggest providers and facilities will face significant challenges just identifying who the convenor should be, who the appropriate co-providers/facilities should be, and how to collect GFEs from these co-providers/facilities," Stellar said.

"Survey respondents were adamant that meeting the legislation's three-day deadline to get the GFE to the patient would be difficult or very difficult. Not surprising, respondents expressed strong support for the government delaying the convenor requirement until a standardized process to exchange data between convening providers and co-providers/co-facilities is established."

Jay Asser is an associate editor for HealthLeaders.


Get the latest on healthcare leadership in your inbox.