- The American Hospital Association is asking the CMS to continue delaying enforcement of a provision within the No Surprises Act that requires certain providers to collect cost estimates from multiple physicians in order to furnish a comprehensive cost estimate in advance for patients.
- The No Surprises Act went into effect earlier this year, but the CMS has delayed enforcement of the "convening provider" provision through the calendar year due to the complexity and time it will take providers to develop systems around the requirement.
- The hospital lobbying group is urging the agency to identify a technical solution that can be implemented by all providers. Until then, the AHA is requesting a continued extension.
The ban on surprise medical bills is well known for its signature achievement: removing patients from the middle of payment disputes between payers and providers.
But there are other lesser-known provisions that experts say are complicating an industry already rife with complex regulations, according to Healthcare Dive's previous reporting.
One element in the No Surprises Act requires providers known as "convening providers" to anticipate additional care a patient may require from other physicians and collect cost estimates from them.
Providers then use those multiple cost estimates to assemble a comprehensive good-faith estimate to patients in advance of a procedure.
The cost estimates are difficult to automate because they require individual patient tailoring and need to be submitted under tight deadlines, further complicating compliance.
The AHA said in a letter to the CMS that practices don’t have this capacity, as billing information is traditionally sent to health insurers but not other providers or facilities.
Due to a lack of automated fixes, "this process would require a significant manual effort by providers," and could "lead to inadvertent errors" because of the short timeframes, the AHA said in a letter sent to the CMS dated June 6.
The AHA also raised concerns in the letter about moving forward without an automated standard in the industry.
Continuing without a standardized process will “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),” the AHA said.