August 17, 2023

Court Ruling, Advocacy Result in CMS Lowering Fee to Initiate No Surprises Act IDR Process

The Centers for Medicare and Medicaid Services (CMS) announced Aug. 11 the repeal of a 600% increase to its fee to file a reimbursement dispute under the No Surprises Act (NSA). CMS’ action is in response to the latest ruling by the U.S. District Court for the Eastern District of Texas in a suit brought against the federal government by the Texas Medical Association, Texas Radiological Society, Houston Radiology Associated and others, that charged the government’s fee increase violated federal law.

CMS late last year raised the fee to file a dispute in the independent dispute resolution (IDR) process created by the NSA from $50 to $350, but the court struck down the increase in an Aug. 3 ruling. The ruling applies only to IDR administrative fees paid on or after Aug. 3, and does not require CMS to adjust or refund administrative fees paid prior to then. CMS’ reversal follows extensive lobbying by the American College of Radiology® (ACR®), the American College of Emergency Physicians and the American Society of Anesthesiologists.

CMS action also follows pressure from U.S. Sen. Bill Cassidy, MD (R-LA), ranking member of the Senate Committee on Health, Education, Labor, and Pensions (HELP), who recently called on the U.S. Department of Health of Human Services Secretary Xavier Becerra to properly implement the NSA. The senator played a key role in developing the NSA and made multiple efforts to ensure physicians can utilize the IDR process in a timely and efficient manner to resolve payment disputes with insurers. In recent months, he has hosted two roundtables aimed at addressing concerns with the IDR process, barriers to batching like claims and increased adjudication fees.

The HELP Committee began gathering input from stakeholders about NSA implementation following the ACR Capitol Hill Day. Ashutosh Rao, MD, in May presented radiologists’ concerns on behalf of ACR to key members and staff of the HELP Committee. ACR staff also attended a HELP committee roundtable last month and submitted feedback to Sen. Cassidy with suggestions to improve NSA implementation.

Through ACR’s advocacy efforts, several of the College’s recommendations were included in Sen. Cassidy’s letter to Secretary Becerra.

In its announcement, CMS indicated that it may take action to set a new administrative fee in future rulemaking. The rulemaking process allows stakeholders the opportunity to provide comments on proposals. ACR is monitoring all NSA rulemaking and will provide comments, as appropriate, to ensure the spirit of the law is followed and radiologists have reasonable access to the IDR process.

For more information or if you have questions, contact Ashley Walton, ACR Government Affairs Director, or Katie Keysor, ACR Senior Director of Economic Policy.