Doctors and medical practices are cheering a decision by the Biden administration to delay enforcement of a rule requiring physician practices to send patients an "advanced Explanation of Benefits" (advanced EOB) prior to performing a test or procedure.
The advanced EOB requirement, part of the "No Surprises" Act transparency rule passed earlier this year by Congress, is designed to give patients advance notice of how much they likely will have to pay out of pocket for a particular test or procedure. As the administration explains on page 6 of this FAQ, which was issued on August 20, "The notification must include: (1) the network status of the provider or facility; (2) the contracted rate for the item or service ... (3) the good faith estimate received from the provider; (4) a good faith estimate of the amount the plan or coverage is responsible for paying, and the amount of any cost-sharing for which the individual would be responsible for paying ... and (5) disclaimers indicating whether coverage is subject to any medical management techniques."
The rule was set to take effect in January 2022. However, "the Departments [of Labor, Health and Human Services (HHS), and the Treasury] have received feedback from the public about the challenges of developing the technical infrastructure necessary for providers and facilities to transmit to plans and issuers, starting January 1, 2022, the good faith estimates required," the FAQ says. "Stakeholders have requested that the departments delay the applicability date of this provision until the departments have established standards for the data transfer between providers and facilities and plans and issuers and have given enough time for plans and issuers and providers and facilities to build the infrastructure necessary to support the transfers."
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