No Surprises Act: Providers Need More Time to Comply, Insurers Using NSA in Rate Negotiations

The No Surprises Act has been a hot-button point of contention among insurers and providers as physician groups feel threatened by the leverage that insurers are given through the Act’s enforcement. The Medical Group Management Association (MGMA) sent a letter to the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) demanding additional notice for the implementation of any new rules having to do with the law’s enforcement.

In the letter to HHS and CMS, MGMA alleged that there was not enough notice provided before the interim final rule establishing the requirements was set in place. Becker’s reports that the tight timeframe created confusion and clarifying resources were not provided in a timely manner. While practices sought to comply with in-house interpretations of the rule, the delay in clarifying materials caused extra work for full compliance. In the future, MGMA requests at least six months between the publication of a final rule and the enforcement date.

From the MGMA letter to HHS:

Group practices are currently facing significant staffing shortages, record-breaking inflation, and significant reductions in Medicare payment. With the increasing financial uncertainty among many practices, funding for additional administrative and support staff, that are responsible for implementing new administrative processes, such as AEOB mandates, is often reduced first. The current environment of the healthcare industry does not lend itself to quick implementation of major policies.

Insurers are also using the No Surprises Act to influence rate negotiations with providers. According to Modern Healthcare, Cigna regularly reviews contracted rates in an effort to bring down costs, and has allegedly cited the Act as a reason that contracted rates may no longer be competitive. Some insurers are asking for pay cuts as high as 50%, according to American Medical Association (AMA) President Jack Resneck Jr.:

We continue to communicate our concerns to regulators that these payer tactics will lead to inadequate networks or access issues. The AMA is monitoring this situation and will work relentlessly to beat back these cynical ploys.