American Hospital Association urges CMS to extend enforcement discretion for No Surprises Act

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The American Hospital Association has urged the Centers for Medicare and Medicaid Services to extend enforcement discretion for the No Surprises Act regulatory requirement that healthcare providers exchange certain information to create a good faith estimate for uninsured and self-pay patients – until the agency identifies, and providers can implement, a standard, automated way to exchange the information.

“In the interim final rule implementing this policy, CMS notes that it is exercising enforcement discretion until Jan. 1, 2023, as it may take time for providers and facilities to ‘develop systems and processes for receiving and providing the required information,'” AHA wrote. “We agree that 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.”

In the federal price transparency rule that took effect January 1, 2021, hospitals were tasked with posting all of their prices online in clear, easily accessible formats. A KLAS survey released in April indicated that hospitals are generally in favor of such regulations as a step towards the consumerization of healthcare.

But concerns over price accuracy and whether patients would fully understand the complexities of procedure costs were augmented by fears from smaller hospitals that consumers would be lured to larger healthcare organizations that, by virtue of their size, could offer lower rates.

One of the main concerns from the AHA is that there are currently no methods for unaffiliated providers to share or receive good faith estimates with a convening provider or facility in an automated manner. 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.

This is not something that practice management systems can generally do, said the AHA, since billing information is traditionally sent to health insurers and clearinghouses, not 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,” the AHA wrote.

AHA requested an extension in enforcement discretion until a technical solution has been found and implemented.

WHAT’S THE IMPACT

Without an automated standard, the AHA said, providers would need to determine individually how to transmit the information. That in turn could lead to variance throughout the industry, especially considering differences in size and technical sophistication among co-providers and facilities. Navigating a non-standardized process, the AHA contended, would increase administrative burden on providers.

To help work toward a standard solution, The AHA said it’s partnering with the American Medical Association, the Medical Group Management Association and HL7 to create a workgroup to discuss potential technical solutions for sharing and receiving critical information among providers. The group will consist of providers and vendors with knowledge of provider systems.

THE LARGER TREND

Although hospitals see value in price transparency, a majority are concerned about significant challenges around deployment of CMS’ price transparency regulation, according to a KLAS survey of 66 revenue cycle leaders. The regulation stipulates hospitals must provide clear, accessible pricing estimates online for at least 300 different shoppable services.

The survey revealed the majority of respondents are concerned significant resource investment will be needed to sustain price transparency and indicated there is widespread confusion regarding the expectations and needs required by the regulations. More than half of survey respondents said they were concerned the implementation and build-out of price transparency systems would continue to eat up valuable resources.

One unnamed vice president of a revenue cycle noted meeting the requirements has added “significantly” to the cost of healthcare. There were also two main technical sticking points regarding the regulation in its current form, one of which requires healthcare systems to produce pricing information files as machine-readable, and the other concerns the regulation’s requirement that providers publish a master list of rates online.
 

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