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Workgroup: Good Faith Estimation Requirement will be "Extremely Challenging to Meet"

Analysis  |  By Alexandra Wilson Pecci  
   December 09, 2021

The Workgroup for Electronic Data Interchange is calling on HHS to delay or adjust many of the No Surprises Act's requirements for providing good faith estimates.

The Workgroup for Electronic Data Interchange (WEDI) is expressing concerns that the "good faith estimation" requirement in the No Surprises Act "will prove extremely challenging to meet."

WEDI expressed these concerns in comments on the Interim Final Rule for the No Surprises Act. It focused those comments on the "good faith estimation" requirement for patients with no insurance or who are self-pay.

Although it's supportive of the intent of the requirement, WEDI doesn't think providers will be able to meet it. In its comments, WEDI called on HHS to make several adjustments to the requirements. WEDI was named in the 1996 HIPAA legislation as a formal advisor the HHS secretary.

It's calling for the following adjustments to the "good faith estimation" requirement:

Implement the good faith estimation requirement in stages: This is especially important because WEDI notes that there "currently are no standards or automated processes for exchanging [good faith estimate] data between providers and facilities, required of the 'convenors.'"

Allow providers and facilities to examine patients before providing a good faith estimate: This will allow providers to generate a good faith estimate for the initial consultation, as well as one that might be needed for additional, and perhaps more complex, services.

Use a percentage, rather than a $400 threshold, for triggering arbitration: Currently, a $400 threshold will trigger the potential of arbitration between the patient and the provider or facility, which WEDI says may "not appropriately reflect the variability of more costly medical services." To remedy this and avoid unnecessary arbitration, WEDI recommends that it should be a percentage of the billed service, rather than a dollar amount.

Delay the convening provider/facility requirement: WEDI says that the government shouldn't require this at all until it establishes and thoroughly tests a standard or automated process for the convening provider or facility to request and collate good faith estimates.

Alexandra Wilson Pecci is an editor for HealthLeaders.


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