- The report highlighted the ongoing burden associated with prior authorization and the good faith estimates included in the No Surprises Act.
- 89% of executives responded that the overall regulatory burden on their medical practices has increased over the past 12 months.
- MGMA urged to delay the implementation of the uninsured or self-pay GFE and the advanced explanation of benefits (AEOB) requirements until the end of CY 2023.
The Medical Group Management Association (MGMA) released its Annual Regulatory Burden survey revealing that medical practices face overwhelming regulatory challenges. The report highlighted the ongoing burden associated with prior authorization and the good faith estimates included in the No Surprises Act. It also covers challenges related to the Medicare Quality Payment Program, audits and appeals, and others.
The survey included responses from executives representing over 500 group practices. According to the survey, 89% of executives responded that the overall regulatory burden on their medical practices has increased over the past 12 months. 97% said that reducing the regulatory burden would allow them to reallocate resources toward patient care.
Main sources of physician frustration
In the report, prior authorization was the top source of frustration, with 81% of executives calling it very or excessively burdensome. In the second place, the Surprise billing & good faith estimate (GFE) requirements at 70%.
Other regulatory issues covered in the report were: Medicare Quality Payment Program (64.56%), Audits and appeals (63.90%), Medicare Advantage chart audits (63.90%), and others.
The top challenges for prior authorization highlighted were:
- Delay(s) in prior authorization decisions.
- Inconsistent payer payment policies.
- Prior authorizations for routinely approved items and services.
Regarding the Surprise billing & good faith estimate (GFE) requirements, on January 2022, providers were required to offer a GFE to any uninsured or self-pay patient detailing what they could be charged for an item or service. The requirement is part of regulations implementing the No Surprises Act, which outlaws surprise medical bills.
MGMA urged Congress to delay the GFE implementation
In an MGMA poll, the association stated that practices need more time to implement GFE requirements appropriately. 90% of the participants answered that the uninsured or self-paid GFE requirements increased the administrative burden on their practices.
In the poll, MGMA urged to delay the implementation of the uninsured or self-pay GFE and the advanced explanation of benefits (AEOB) requirements until the end of Calendar Year (CY) 2023 to:
- Provide the Department with time to draft and implement effective policies.
- Provide practices with the time necessary for proper implementation.
- Ensure patients are aware of their rights to price transparency information.
In the Annual Regulatory Burden Report, the MGMA found that 82% of practices said the estimated requirement increased their administrative burden. In addition, 74% of practices do not have the technical infrastructure ready to comply with the new requirements in 2023.
Stay tuned for this and more industry news through our November 2022 newsletter. Subscribe to our monthly newsletter and our Health Prime blog for ongoing leading industry medical practice articles and policy updates.
