On Nov. 15, 2022, we submitted comments to the administration on a recent Request for Information (RFI) on the advanced explanation of benefits (AEOB) and good faith estimate (GFE) requirements of the No Surprises Act. The RFI sought input on transferring data from providers and facilities to health insurers. Our comments on the RFI outlined our concerns regarding the complexity of GFE requirements that have been established for self-pay patients and the unique considerations for pediatrics in the technological transfer of this information between provider and payer.
Other recent action related to the implementation of the No Surprises Act includes the release of a final rule on Aug. 19, 2022 that implements provisions related to the independent dispute resolution (IDR) that will be used to resolve provider/insurer payment disputes in surprise billing situations. The final rule revises provisions from an October 2021 interim final rule that required arbiters to choose the rate closest to the area’s median in-network payment for the services. Those provisions were struck down by a Texas District Court in February 2022. The August final rule moves away from those requirements but provider groups remain concerned that it could lead to narrow networks, reduced access to care for patients and unsustainably low provider payments.
