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- CMS Responds to CAP’s Request for Changes to Surprise Bill Rules
Regulators implementing the No Surprises Act replied to the CAP’s requests for changes to rules for the law’s independent dispute resolution process where physicians and insurers can settle claims for out-of-network services. The CAP has urged the government to issue strong rules to prevent health insurance plans from manipulating payments to pathologists and laboratories.
The CAP has advocated for changes to regulations by the Centers for Medicare & Medicaid Services (CMS) that have implemented the law. There have been several iterations of rulemaking as physicians have won court challenges to how the CMS has implemented the law and the independent dispute resolution process. On April 10, the CAP sent a letter to CMS calling for specific changes to the open negotiation process, batching, and administrative fees.
In response to the CAP’s comments on batching claims during independent dispute resolutions, the CMS said the government is considering potential improvements to its batching policy and the CAP’s insight on the issue will be helpful during ongoing conversations. The CAP has also raised concerns regarding fee increases.
In 2023, the administrative fee was raised to $350 from $50 per party per dispute. A pathology claim is often less than $350 and the current batching requirements make packaging multiple claims into a single dispute difficult, which compounds the cost effectiveness of participating in the dispute process. The CAP has recommended that the administration rescind the fee increase and allow more flexibility for batching claims. The CMS said the fee increase has been necessary to administer the federal independent dispute resolution process and meet the needs of disputing parties. Without the fee increase, the process would yield slower payment determinations.
Read the full response letter from the CMS.