The Centers for Medicare & Medicaid Services is delaying enforcement of a key provision in the No Surprises Act, drawing support from radiologists and other physicians.
First approved in December, the legislation is slated to ban providers from sending patients unexpected medical bills for out-of-network care beginning in 2022. The feds would also require insurers to send beneficiaries an “advanced explanation of benefits” either via mail or electronically, including a “good faith” estimate of how much the service might cost.
However, after receiving feedback about the potential challenges of such a change, CMS said it will not crack down on those who violate this part of the rule in four months.
“The Departments [of Labor, Health and Human Services] agree that compliance with this section is likely not possible by January 1, 2022, and therefore intend to undertake notice and comment rulemaking in the future to implement this provision, including establishing appropriate data transfer standards,” CMS said in a notice posted Aug. 20.
The American College of Radiology said Wednesday that it appreciates the administration’s flexibility. ACR previously pushed for provisions in the bill to help hold patients harmless in physician-insurer disputes and resolve such disagreements in an equitable manner.
“We want to ensure that explanation of benefit provisions and infrastructure are instituted correctly and in a sustainable manner that all can be happy with,” ACR said in a statement.
Both the American Medical Association (AMA) and Medical Group Management Association (MGMA) also support the delay. The latter said it’s “relieved” by the decision amid concerns the requirement could lead to erroneous accounting of what patients owe, MedPage reported Tuesday.
“An unintended consequence of this requirement could be scaring patients out of seeking treatment due to expensive, incorrect estimates,” said Anders Gilberg, senior VP for government affairs at MGMA, which represents more than 15,000 medical practices in radiology and other specialties.
Imaging experts reported earlier this year that they expect the legislation to have a substantial impact on radiology practices, regardless of their network status.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.