The American Hospital Association wrote to the Centers for Medicare & Medicaid Services earlier this week, calling on the agency to offer further guidance about – and postpone enforcement of – a key piece of the No Surprises Act.
In a letter to CMS Administrator Chiquita Brooks-LaSure, AHA Executive Vice President Stacey Hughes expressed concerns about the feasibility of requirements around “convening provider” and “co-provider” data exchange.
The No Surprises Act requires that convening providers – defined as “the provider or facility who schedules an item or service or who receives the initial request for a good faith estimate from an uninsured (or self- pay) individual” – exchange information with other co-providers who are part of a patient’s care team to help shape a more comprehensive cost estimate.
But “there are currently no methods for unaffiliated providers or facilities to share or receive good faith estimates with a convening provider or facility in an automated manner,” said Hughes in her letter to CMS.
“To share this information, billing systems would need to be able to request and transmit billing rates, discounts and other necessary information for the good faith estimates between providers/facilities.”
As such, AHA is asking for “additional guidance and a longer implementation timeframe” to enable this exchange, noting that most practice management systems don’t have those capabilities, since their billing information is usually sent to payers and clearinghouses, but not often to other providers.
“Due to the lack of currently available automated solutions, this process would require a significant manual effort by providers, which would undoubtedly result in the convening provider being unable to meet the short statutory timeframes for delivering good faith estimates to the patients and could also lead to inadvertent errors,” said Hughes.
With CMS enforcement of No Surprises set to start, potentially, on Jan. 1, 2023, AHA is concerned that its hospital members might be unable to meet that deadline with the information exchange ecosystem as it currently exists.
“Developing and implementing the solution will take time and cannot be achieved efficiently without additional guidance from CMS that identifies a standard technical solution that can be implemented by all providers,” said Hughes. “We request an extension in enforcement discretion until a technical solution has been identified and implemented.”
Without such an automated standard, she said, “providers would need to individually determine how to transmit this information, which would inevitably lead to widespread variance throughout the industry (particularly given the differences in size and levels of technical sophistication among co-providers and co-facilities).
“Navigating a non-standardized process would place an enormous administrative burden on providers, beyond what regulators likely considered prior to creating the implementation and enforcement dates,” said Hughes.
THE LARGER TREND
The American Hospital Association is not the first industry group to raise concerns about the No Surprises Act’s exchange provision. In March, the Workgroup for Electronic Data Interchange offered comments to CMS highlighting similar challenges.
For its part, the AHA notes in its letter is working toward a solution by partnering with the American Medical Association, the Medical Group Management Association and HL7 – along with several IT vendors – to discuss technologies that can help with information sharing among different provider sites.
ON THE RECORD
“A standard technology or transaction that would enable convening providers and facilities to automate the creation of comprehensive good faith estimates is necessary to efficiently implement the full uninsured/self-pay good faith estimate,” said Hughes in her letter.
“We urge CMS to continue to exercise enforcement discretion with respect to the comprehensive good faith estimate requirement until a technical solution for exchanging this information is developed and implemented across all providers.
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