The Centers for Medicare & Medicaid Services (CMS) released new guidance that seeks to clarify requirements
for electronic funds transfers (EFT).
Although this guidance does not address all of MGMA’s questions and concerns (see MGMA’s letter to CMS), we are encouraged that CMS heeded our call to issue additional guidance and that CMS acknowledged in this guidance that a health plan may not adversely affect or attempt to adversely affect a provider, should a provider desire to receive EFT using a standard transaction
MGMA has voiced concerns to CMS that the business associates that health plans use to render payments to practices levy fees on the transaction. We are adamant that these ‘pay to get paid’ schemes are unacceptable and that CMS should prohibit these abuses. Although the guidance does not explicitly address these fees, it does clearly state that health plans cannot require providers to receive payment from its business associates. In essence, as we understand it, the fact that a plan cannot require a practice to agree to receive payment from its business associates should allow practices to forgo interacting with these vendors and thus avoid the fees.
MGMA is seeking further clarity on this guidance and stands firm on our belief that health plans and their business associates should be forbidden from levying these fees on medical groups.