Enforcement for certain good faith estimate (GFE) provisions are being delayed.
CMS recently gave revenue cycle leaders an extension of its enforcement discretion on the convening provider requirements that are part of the GFE in its newest FAQ.
Under the law, healthcare organizations need to give patients who don't have certain types of healthcare coverage—or those who are paying out of pocket—an estimate of their bill before services are provided.
Not only do these GFEs need to be created, but they also need to be created quickly as patients have the right to receive a GFE for the total expected cost of items and services as soon as they schedule an appointment (the items can include costs of tests, drugs, equipment, hospital fees, and more).
The GFEs also need to be accurate since patients can dispute final medical bills if the charges are at least $400 more than what was presented on the GFE.
On top of all of this, the rule also includes a "convening provider" requirement.
This means GFEs need to cover not only the provider’s own services, but those of downstream providers expected to be needed to complete treatment.
This specific requirement has been an area of contention for hospitals and medical groups. In fact, the MGMA recently pleaded with CMS to extend the enforcement discretion for the convening provider/facility and co-provider/facility provisions for GFEs.
At the time the MGMA said enforcement discretion should continue until appropriate standards have been developed, tested, and implemented by group practices.
According to the recently published new guidance, CMS said HHS is extending enforcement discretion, pending future rulemaking, for situations where GFEs for uninsured or self-pay individuals do not include expected charges from coproviders or co-facilities until further notice.
Enforcement of this part of the No Surprises Act requirement was expected to start January 1, 2023.
WEDI recently applauded this guidance and Charles Stellar, WEDI president and CEO, went on to say that "the industry continues to make progress in developing data interchange standards to support the requirements of the No Surprises Act. We commend HHS for extending the enforcement discretion period and averting significant administrative burdens on providers. The HHS action today grants the time necessary to develop cost efficient solutions and implement supporting regulations."
Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.
GFEs need to cover not only the provider’s own services, but those of downstream providers expected to be needed to complete treatment.
Enforcement of this part of the No Surprises Act requirement was expected to start January 1, 2023, but has now been delayed until further notice.