Hospitals across the U.S are pushing federal officials to change the surprise-billing dispute resolution process and provide clarity on good faith estimates for uninsured patients.
CMS unveiled Sept. 30 a second interim final surprise-billing rule that outlined several provisions of the No Surprises Act, including the federal independent dispute resolution process and good faith estimate requirements for uninsured patients. Comments on the interim final rule were due Dec. 6.
While the American Hospital Association, which represents nearly 5,000 hospitals, supports protecting patients from out-of-network surprise bills, the association argues that the independent dispute resolution process adopted by the federal agencies will be effectively "unavailing for providers."
In particular, the association takes issue with a metric that will be used in the dispute resolution process known as the qualifying payment amount, which is the insurer's median in-network rate. Hospitals argue that having arbiters presume that the health plan's contracted rate is the appropriate out-of-network reimbursement rate unfairly favors payers, would render other factors less important and goes against what is written in the No Surprises Act.
"What was supposed to be an independent check on both parties is now gone," the AHA wrote in its comment letter. "In short, the departments have forfeited this important restraint with respect to plans and issuers, while creating a nearly insurmountable set of conditions for providers."
The Federation of American Hospitals also submitted comments about the rule, writing in its letter that HHS, the Labor Department and Treasury Department don't have the authority to impose a presumption that the qualifying payment amount is the appropriate out-of-network rate and "to otherwise transform IDR effectively into a rate-setting process."
HHS Secretary Xavier Becerra previously defended the CMS surprise-billing rule, saying that while the administration chose a benchmark that physician and hospital groups don't like, the rule does specify that other factors should be considered by the arbiter in the dispute process.
In addition, the AHA is recommending that HHS allow hospitals compliant with the price-transparency rule to use patient cost estimators to provide good faith estimates.