Most medical groups are still being charged fees they didn’t agree to by insurers to receive electronic payment, according to a new MGMA Stat poll.
A Nov. 28, 2023, MGMA Stat poll asked medical group leaders, “Are insurers charging your practice fees you didn't agree to in order to receive electronic payments?” A majority (60%) responded “yes,” while 41% responded “no.” [Editor’s note: Figures do not add up to 100% due to rounding.] There were 286 applicable responses.
Among medical group leaders whose organizations are facing fees for electronic funds transfer (EFT):
- More than six in 10 (62%) said the average fee charged was 2% or more of their reimbursement, with nearly one in three (32%) noting they face a 3% fee for electronic payments.
- Another 11% of respondents told MGMA they face an average 1% fee on their reimbursements sent via electronic payment.
- About one-quarter (27%) of respondents were unsure or responded “other” about average fees they face.
Over the years, MGMA members have seen health plans and their payment processing vendors impose fees just to process payment electronically. An Aug. 10, 2021, MGMA Stat poll similarly found that 57% of medical practices said insurers charge fees they didn’t agree to when sending payments via EFT.
Rapacious EFT fees unnecessarily increase costs for practices
As instituted under the Affordable Care Act, health plans are required to offer practices the option of receiving reimbursement through a standardized EFT method. Certain health plans require medical groups to use third-party vendors to receive electronic payment, and these vendors often charge a percentage fee per EFT transaction.
The Centers for Medicare & Medicaid Services (CMS) removed guidance from its website in 2017 that clearly prohibited health plans and their third-party vendors from engaging in these unfair business practices. These fees are contrary to CMS’ obligation to reduce the administrative costs of providing and paying for healthcare. If a medical group does not sign up for electronic payment, they must receive reimbursement through virtual credit cards (which also come with fees) or checks in the mail.
#MGMAAdvocacy
For years, MGMA has been advocating for CMS to release guidance clearly forbidding these harmful practices. While CMS issued new guidance in 2022, it did not fully reinstate the 2017 FAQ and, as such, did not solve the problem. MGMA continues to hear from medical groups about fees they are being charged to receive EFT payments.
We have been working with Congress to codify protections prohibiting health plans and vendors from charging predatory fees for EFT payments. On Nov. 28, the bipartisan No Fees for EFTs Act was introduced by U.S. Reps. Greg Murphy, MD, Derek Kilmer, Morgan Griffith, Ami Bera, MD, Mariannette Miller-Meeks, MD, and Kim Schrier, MD. This is a great step toward solving this problem and protecting the financial viability of medical groups.
Additional resources
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