At the end of 2022, CMS announced a 600% administrative fee hike to access the IDR process, which was met with much opposition from a variety of physicians and physician groups. The Texas Medical Association even filed a lawsuit in protest. Here are examples of advocacy surrounding this controversial decision.
These fees, meant to cover the IDR’s eligibility determination process, mean providers must now pay $350 per case (previously $50 per case) AND wait for months, possibly even years, for the cumbersome process to carry out.
Instead of inflating the fees, the ASA suggests that CMS works on clarification of requirements, an audit process, and educating healthcare providers on the IDR process.
ASA President Dr. Michael Champeau stated, “While we understand there are administrative costs to the IDR process, those costs must be balanced with the need for legitimate access. An administrative fee will create a huge barrier to participating in the IDR process and resolving claims equitably”, especially for small practices with limited resources.
Read more about the ASA’s opposition in this article: https://lnkd.in/eUvQxWPX
1/6/23: In this OpEd, a radiologist expresses his concerns over the 600% fee surge for access to the IDR process.
Since radiologists’ claims are almost all under $350, they are effectively losing money to recover their lost revenue.
The radiologist, Dr. Richard Heller, provides three alternatives to these fees: widening the batching of claims, penalizing only the loser of arbitration with a fee, or using a smaller fee, paid by both parties.
“With the support of the medical community, the No Surprises Act was passed to protect patients from surprise bills. CMS should show physicians the same respect,” says Heller.
1/13/23: More backlash to the IDR administrative fee surge: on January 13th, four voices shared their thoughts on the price hike in this piece from Radiology Business.
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)— stated that they “strongly oppose” the surge in fees, in powerful statements from their leaders to CMS.
The bottom line: the dramatic, unprecedented increase in initial fees with less than a week’s notice disproportionately affects providers, favors health plans, and will hurt consumers.
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