Staging the Data Exchange Provisions of the No Surprises Act: One Pathway to Success
December 9, 2021
Written by Robert Tennant, Vice President Federal Affairs
In submitting our comments in response to the Interim Final Rule with Comment (IFR) entitled, “Requirements Related to Surprise Billing; Part II,” WEDI reiterated support for the intent of the legislation-ensuring patients will not suffer from potentially catastrophic bills for out-of-network services or from out-of-network facilities. At the same time, we raised concerns regarding the requirement that providers and facilities generate a good faith estimation (GFE) for uninsured or self-pay patients for every scheduled service and recommended staging implementation of the GFE and other data exchange provisions of the No Surprises Act.
The industry faces significant challenges exchanging the data needed to meet the legislative requirements. Currently, there are no standards or automated processes for exchanging GFE data between convening and supporting providers and facilities and no standards or automated processes to exchange GFE data with health plans. Absent a standardized methodology, the industry will inevitably develop one-off proprietary solutions that will severely tax providers and facilities and potentially delay patient access to this information. WEDI urged policymakers to identify opportunities to facilitate patients having access to pricing data through other methods while delaying full implementation of the data exchange mandates until standards are established, implemented and tested.
As part of this staging process, we proposed having patients themselves initiate the request for a GFE. This would not only decrease the initial GFE volume but would address the potential confusion of the patient receiving a GFE without requesting it, and perhaps believing it to be a bill. As well, for the patient to receive the most accurate GFE, especially for more complex medical services, providers and facilities should be permitted to evaluate the patient prior to generating a GFE. Most importantly, offer providers, facilities and health plans the option of posting prices online as an alternative to the GFE and Advanced Explanation of Benefits, similar to what is now required of hospitals through the price transparency regulations.
Staging can allow the industry to meet the spirit of the legislation without imposing a considerable administrative burden on stakeholders. The approaches WEDI has outlined will permit the industry and federal government additional time to develop and implement data exchange standards and automated processes while still providing patients the information they need to compare costs effectively and efficiently.