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- CAP Asks Federal Agencies to Reduce Fees for Federal IDR Process
The CAP strongly urged the departments of the Treasury, Labor, and Health and Human Services to reconsider increasing the independent dispute resolution (IDR) process administrative fee from $50 to $150 per party, as any increase in the administrative fee amount imposes added burdens and potentially a complete barrier for physicians in accessing the federal IDR process and is especially difficult for pathologists.
In an October 24 letter to the departments, the CAP urged the government to reduce the administrative fee amount for disputes that involve low-dollar claims. The CAP argued that by precluding the overwhelming majority of pathology claims from the IDR process, this administrative fee amount would inject a serious inequity into the process and undercut the critical balance the legislation sought to achieve. The CAP also supports a proposal to set the ranges for certified independent dispute resolution (IDR) entity fees in notice and comment rulemaking, with the certified IDR entities providing their fees on an annual basis. Further, while the IDR entity fee is returned to the prevailing party, the CAP proposes the Departments consider the upfront finances needed when setting the certified IDR entity fee ranges.
In the letter, the CAP encouraged the departments to maintain predictability and consistency with the administrative fee process. The CAP has worked closely with Congress and other stakeholders in the development of the No Surprises Act and has repeatedly called for protections that keep patients out of the middle of billing disputes.
On October 27, the Departments released the proposed rule. The CAP has repeatedly asked for a more formalized open negotiation process, which they are proposing, as well as more flexible batching, which is being provided in particular for pathology. The CAP continues to believe that regulations must support an equitable and balanced system for resolving payment disputes, to ensure fair reimbursement for out-of-network services and IDR process that is accessible to all.
For more information read: No Surprises Act Independent Dispute Resolution Process Proposed Rule Fact Sheet.