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UrduThe whopping fee increase was announced on Friday, December 23 by the Centers for Medicare and Medicaid Services (CMS). For 2022, the fee was a modest $50. The new fee is $350 and is not refundable. The administrative fee increase is in addition to a previous hike in the arbitration fee schedule announced on October 31, 2022.
“Our members, especially our members in small and medium-sized community practices, are more frustrated than ever with this broken IDR process,” said ASA President Michael Champeau, M.D., FASA. “Our practices are trying to navigate highly suspect payer-calculated Qualifying Payment Amounts (QPA) and unworkable batching rules. CMS has acknowledged there is a significant backlog of disputes pending determination, in addition to many challenges regarding the eligibility of such disputes. And now our members must pay these outrageous fees to get the money they are owed.”
CMS argues that the administrative fee increase is necessary because the process of determining eligibility for the Federal IDR process has been “a more significant burden” than the Departments anticipated, and that the volume of claims submitted has far exceeded expectations. “The blame for the high volume of disputes rests squarely with payers and their unreasonably low QPAs,” said Dr. Champeau. “If payers were making initial payments based on real market-based rates, our members would have no reason to utilize the IDR process. For now, our members’ only chance of relief from the low QPAs is the IDR process.”
CMS also cites that many of the disputes submitted are ultimately deemed ineligible for the IDR process. These circumstances indicate that the Departments’ rules are insufficient and unclear and more guidance is needed. This also reflects the fact that the Departments have not yet implemented the payer auditing rules. The NSA directed the Departments to establish the payer auditing process through rulemaking procedures by October 1, 2021. The auditing process aims to ensure that payers are complying with the QPA requirements. To date, the Departments have not engaged in such rulemaking and, as a result, there is not yet any mechanism for holding payers accountable for their compliance with the law. “If the Departments had implemented the payer auditing rules, as Congress directed, the volume of disputes would likely be much lower,” noted Dr. Champeau.
“Rather than increasing fees to an exorbitant rate – a rate that is going to be a particular deterrent for small practices that don’t have many resources – CMS should work on clarifying its rules, implementing the audit process, and educating the health care community on the IDR process,” stated Dr. Champeau. “As such, ASA urges CMS not to implement the administrative fee increase at this time. 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 of $350 will create a huge barrier to participating in the IDR process and resolving claims equitably.”
About the American Society of Anesthesiologists Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook and follow ASALifeline on Twitter.
