CMS Delays Enforcement of Surprise Billing Requirement Tied to Interoperability

The U.S. Department of Health and Human Services has announced it will delay enforcement of a provision from the 2020 surprise billing law. This delay affects cost estimates that facilities and providers must give to people without insurance or who choose to pay out of pocket.

The Centers for Medicare & Medicaid Services (CMS) had originally planned to start enforcing the requirements Jan. 1, 2023, but will delay the decision “pending future rulemaking," and to allow time for providers and facilities to develop mechanisms for data and information sharing.

Many facilities and providers may not have a standard list of procedure costs for the uninsured and self-pay patients. Since insurer rates vary, setting standard rates is a complex problem. Even if they do have price information, facilities and providers do not routinely share their pricing information with each other.

To make things even more difficult, no standard technical solutions and business practices yet exist for sharing such information.

The FAQ notes that the Department of Health and Human Services got many comments asking that the agency “further delay the enforcement of this provision until HHS has established a standard technology or transaction to automate” combined estimates.

Commenters also noted that providers and facilities would then need to adopt these standards. It is unclear when the agency might adopt a standard technology for sharing cost information.

For help complying with the surprise billing law, review our detailed guide to compliance. CMS has also compiled several FAQs on good-faith estimates.