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.
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