The American College of Radiology and two other specialty societies are urging the federal government to resume dispute resolutions that have been paused under the surprise-billing legislation. Failure to act, they charge, could prove detrimental to physicians and their patients.
On Feb. 6, CMS halted the process for settling payment disputes between providers and payers under the No Surprises Act, which took effect in 2022. The move came after a federal judge ruled that parts of the process for solving such disagreements are in violation of the Administrative Procedure Act.
ACR, the American College of Emergency Physicians and the American Society of Anesthesiologists applauded the judge’s decision last month. But now they want the federal government to resume the process.
“The medical associations assert that the government’s pause exacerbates the existing backlog of IDR determinations, causing harm to healthcare providers who provided those services,” ACR et al. said in a news update shared on Monday, March 6.
All three societies made their case to CMS in a Feb. 28 letter to Ellen Montz, PhD, deputy administrator and director of the Center for Consumer Information and Insurance Oversight. They contend that payers have been using “unreasonably low” initial payments and “aggressive” negotiation techniques that push practices out of network. This leaves no choice but to utilize the IDR process to receive a reasonable payment.
“Our members’ practices, particularly small and medium sized community-based practices, are being hurt every day as they provide the needed patient care and then have to await long-delayed payment determinations,” they wrote.
CMS provided some relief on Feb. 24 when it announced that arbitrators could resume making some payment determinations. However, this only applied to any out-of-network services furnished before Oct. 25, ACR noted in a separate news update issued on March 2. The doc groups emphasized that the hold only applies to payment determinations made by the independent dispute resolution entities, and “all other timelines for the IDR process continue to apply.”
In its recent update, CMS said the federal government is working “diligently” to complete necessary guidance and system updates to allow IDR entities to resume processing payment determinations for all instances.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.