aamc.org does not support this web browser.
  • Washington Highlights

    HHS Seeks Feedback on No Surprises Advanced EOBs, Good Faith Estimates


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

    The departments of Labor, Health and Human Services, and Treasury and the Office of Personnel Management released a request for information (RFI) on Sept. 14 for rulemaking for the advanced explanation of benefits (EOB) and the good faith estimate (GFE) requirements under the No Surprises Act (P.L.116-260) [refer to Washington Highlights, Dec. 23, 2020]. Specifically, the RFI seeks information and recommendations on transferring data from providers and facilities to plans, issuers, and carriers.

    Under the No Surprises Act, providers are required to provide individuals with a GFE of expected charges for scheduled services. The GFE should include billing and diagnostic codes for the items and services reasonably expected to be provided in conjunction with those items and services. For individuals enrolled in a group health plan or group or individual insurance coverage, the GFE is sent directly to an individual’s health plan. Upon receiving the GFE, the health plan would then be required to issue an advanced EOB to covered individuals for the scheduled items and services. The advanced EOB must include the amount the plan or coverage is responsible for paying and the amount of any cost sharing the covered individual would be required to pay, in addition to other information.

    Comments on the RFI are due Nov. 15.