Groups clash with CMS over independent dispute resolution
Last month the federal government raised the administrative fee providers and/or payers have to shell out when seeking independent dispute resolution of reimbursements under the No Surprises Act.
Specifically, HHS via CMS, along with the U.S. Labor and Treasury departments, announced an executive action changing the admin fee from $50 to $350.
That’s a 600% jump, and it took effect on New Year’s Day.
Two weeks later, on Jan. 13, the heads of four medical management associations locked arms and pointed their voices in the general direction of Washington.
“The Associations call on CMS to fairly rebalance the independent dispute resolution (IDR) process, keep administrative fees at fair and stable 2022 levels, and address their unsustainable backlog of claims under the No Surprises Act,” the executives said in written remarks. “To ensure this appropriate and much needed reform at CMS, the Associations call on the new Congress to initiate oversight proceedings on these processes at CMS.”
The groups—the Radiology Business Management Association (RBMA), Emergency Department Practice Management Association (EDPMA), Healthcare Business Management Association (HBMA) and Medical Group Management Association (MGMA)—also stated they “strongly oppose” the price hike.
The four called on CMS to “immediately reverse this decision” and on Congress to “initiate oversight proceedings” on it.
The Jan. 13 remarks contain some contextualizing background notes:
After first announcing in October 2022 that the 2023 administrative fee would remain stable, in a last-minute move in late December 2022, CMS announced a 600% increase in non-refundable administrative fees for any party to file out-of-network claims disputes through the NSA’s IDR process. Additionally, CMS had previously announced fee increases of up to 117% for IDR entities. The dramatic, unprecedented increase in initial fees with less than a week’s notice disproportionately affects providers, favors health plans, and will hurt consumers.”
Here are the statements issued by the leaders of the four associations.
Bob Still, executive director, RBMA: “RBMA fully supports Congress’s intention of the No Surprises Act (NSA) to protect patients from unexpected medical bills, and our physicians are committed to providing affordable, quality care to their patients across the country. As such, this 600% fee increase under the NSA puts physicians in the middle of health plans and CMS’s inadequate implementation process of those plans. By pricing out the method for dispute resolution with this excessive fee, our providers’ ability to perform important services, like cancer screenings, will be significantly hindered and inevitably hurt the healthcare of American consumers.”
Don Powell, chair, EDPMA: “While EDPMA understands CMS’s need to address the IDR backlog, exorbitant fees are simply not the answer. These abrupt, inappropriate increases unnecessarily burden emergency medicine clinicians and significantly deter clinicians’ access to the method of dispute resolution provided by Congress. This is another substantial misstep that fails to address fundamental operational and policy-related issues involved in the No Surprises Act. CMS’s actions prevent the level playing field provided in the law, and contrary to the law’s interests, will drive more payer-driven contact terminations while crippling the cash flow that supports emergency care for patients.”
Landon Tooke, president, HBMA Board of Directors: “Increasing the administrative fees for the IDR process by 600% is not the appropriate way to address the backlog of IDR disputes. The new fee—which is not reimbursed to the initiating party—is higher than many of the disputed payment amounts. This unfairly disincentivizes clinicians from utilizing the IDR process and does not align with how Congress intended this process to be used. The higher fee does not address the root cause of the backlog, which is health plans forcing many practices out of their networks which puts a greater burden on the IDR process. While we understand the need to address the high volume of initiated disputes, health plans share the responsibility to reduce the backlog by properly communicating if the NSA protections apply to a specific scenario and by negotiating in good faith during the open negotiation window.”
Anders Gilberg, senior VP of government affairs, MGMA: “MGMA supports the goals underpinning the No Surprises Act—we believe patients should have accurate and timely access to the costs of items and services. However, the law must be implemented in a manner that does not create undue burden on our nation’s medical groups, nor impede practices’ ability to deliver care. Increasing the administrative fee for the IDR process will disproportionally affect providers who are already suffering from significant financial strain stemming from staffing shortages, wage inflation and drastic cost increases across the board. We encourage CMS to swiftly reevaluate the administrative fee, to make it equitable so as to not prohibit medical groups’ ability to initiate the IDR process to settle payment disputes with health plans as granted by the law.”
CMS’s December memo on the fee hike is here. The call for IDR amendments from the four association heads is here.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.