The group claims the fee hike will strip many physicians and providers of the arbitration process Congress enacted.
February 1, 2023 – Jeff Lagasse, Associate Editor –
The Texas Medical Association is challenging a 600% hike in administrative fees for seeking federal dispute resolution in No Surprises Act situations. TMA filed a lawsuit in the U.S. District Court for the Eastern District of Texas this week, the group’s fourth challenging various aspects of the NSA.
The group claims this “steep administrative fee hike” will strip many physicians and healthcare providers of the arbitration process that Congress enacted. TMA calls the fees “arbitrary and capricious,” contrary to the law and in violation of notice and comment requirements.
WHAT’S THE IMPACT
The U.S. departments of Health and Human Services, Labor and the Treasury, as well as the U.S. Office of Personnel Management, collectively adopted interim final rules implementing the federal surprise billing law. The rules include establishing the nonrefundable administrative fee all parties must pay to enter the federal independent dispute resolution (IDR) process in the event of a payment disagreement between an out-of-network physician or provider and a health plan in circumstances covered by the law.
The situations could occur when emergency services are provided by a doctor or healthcare provider outside of the patient’s insurance network or when out-of-network services are provided at an in-network facility.
The federal agencies set the initial administrative fee at $50 and announced in October 2022 it would remain at $50 for 2023. Two months later, said TMA, the agencies announced a 600% hike in the fee to $350 beginning in January 2023, “due to supplemental data analysis and increasing expenditures in carrying out the Federal IDR process since the development of the prior 2023 guidance.”
