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  • Washington Highlights

    AAMC Submits Comments on No Surprises Act Request for Information

    Mary Mullaney, Director, Hospital Payment Policies
    Gayle Lee, Director, Physician Payment & Quality
    For Media Inquiries

    The AAMC Nov. 7 submitted comments in response to the request for information (RFI) on the implementation of the good faith estimate and advanced explanation of benefits (EOB) requirements under the No Surprises Act (P.L. 116-260). The RFI was issued by the departments of Health and Human Services, Treasury, and Labor and the Office of Personnel Management.

    The letter noted that AAMC members support safeguards to protect patients from surprise medical bills. However, there is concern that some patients, including those with insurance coverage, may delay needed care based on their cost-sharing liability. The letter asked that patients’ access to medically necessary care not be negatively impacted when implementing the requirements for issuing an advanced EOB.

    The No Surprises Act requires health plans to deliver an advanced EOB to patients before care is provided. Insurers create the advanced EOB by using a good faith estimate of expected charges from providers. Currently, however, there is no standardized framework in place for the exchange of this information. The letter asked that the advanced EOB requirements be delayed until a standardized framework is in place.

    The association also called on the departments not to implement the requirement for a convening provider to gather information on expected charges from all co-providers and incorporate this information into one good faith estimate that is sent to the insurer. The volume of this information could be overwhelming and burdensome for the convening provider. There is also concern that requiring co-providers to supply proprietary information on rates to the convening provider could violate confidentiality agreements between providers and insurers. Instead, the letter stated, each billing provider should be allowed to submit their own good faith estimate to the health plan only for items and services that will be billed to the patient’s health plans. “The responsibility for combining the [good faith estimates] into one Advanced EOB should rest with the insurers,” the letter stated.