Centers for Medicare & Medicaid Services (CMS) regulators recently responded to a letter sent by the College of American Pathologists (CAP) to advocate for changes to the independent dispute resolution (IDR) process of the No Surprises Act.
In the April 10 letter to the Department of Health and Human Services and CMS, the CAP wrote that strong rules are needed to protect pathologists and laboratories from unfair billing practices by private insurance companies and urged regulators to consider specific changes to the IDR process, including changes to batching claims, administrative fees, and the open negotiation process.
Having greater flexibility when batching qualified IDR items and services would increase procedural efficiency, according to the CAP. In a May 2 Advocacy Update, the CAP said CMS regulators responded that they are considering improvements to the batching policy and are open to input from the CAP as conversations unfold.
The CAP also decried an increase in IDR administrative fees from $50 to $350 per party per dispute. According to the CAP, the added expense puts insurance companies at an advantage over small and rural providers. CMS responded that such an increase was necessary to deliver payment determinations effectively and efficiently, claiming that payment determinations would be delayed without the fee increase.
In the letter, the CAP also expressed concern about the 30-day open negotiation process, claiming it is being abused by insurers and used as a “delay tactic” rather than an opportunity to engage in good faith negotiations. CMS previously clarified that insurance companies are prohibited from using proprietary online portals that put providers at a disadvantage. No response was noted about suggestions that further efforts to formalize the process would benefit all parties.
Sources:
https://www.cap.org/advocacy/latest-news-and-practice-data/may-2-2023#story3
https://documents.cap.org/documents/cap-letter-IDR-april-2023.pdf
