The Centers for Medicare & Medicaid Services (CMS) announced that they would delay the GFE enforcement in an effort to give providers and facilities time to adopt the necessary interoperable technology for data exchange.
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released an FAQ outlining recent enforcement developments. In this FAQ, it was announced that federal regulators would not be enforcing the upcoming 2023 requirement for providers to include co-provider and co-facility charges in good faith estimates (GFE) to uninsured and self-pay patients, stemming from the No Surprises Act (NSA).
“By extending this exercise of enforcement discretion, [the Department of Health and Human Services (HHS)] aims to promote further interoperability across the healthcare industry,” the FAQ said.
The No Surprises Act, which went into effect in January 2022, intends to ban surprise medical bills by requiring providers to offer good faith estimates to uninsured or self-pay patients of the charges they can expect for visits, tests, and other items or services. The law also called for the estimates to include the potential charges that may stem from a co-provider or co-facility starting on January 1.
Since announcing the original provision, HHS has received comments and feedback indicating that compliance would likely not be possible by January 1, 2023, due to the challenges involved with adopting the proper technical infrastructure necessary for this level of data exchange, prompting the delay.
This delay of enforcement will allow time for providers and facilities to explore business workflow structures and encourages them to focus resources towards adopting interoperable processes for exchanging information.
For more information on the regulations and guidance regarding the NSA, visit the CMS website. You can also review NSA conditions for ASCs on the ASCA NSA webpage.
ASC Interoperability with SIS Complete
Having ASC technology that allows you to pull together important case data from your center and your referring provider, have a clear view into case costing, and prepare a consolidated statement, is quickly becoming a top priority for surgery centers. This doesn’t mean you need to risk additional staff hours, though.
Implementing interoperable software, such as SIS Complete, allows you to share detailed case information, flow this data into your revenue cycle, and efficiently move forward with sharing patient estimates as soon as you receive them.