AMGA Calls on CMS to Reform the Federal IDR Process

Good Faith Estimates Creates Burdens on Providers

Alexandria, VA – AMGA today recommended changes to the surprise billing federal independent dispute resolution (IDR) process included in the “Requirements Related to Surprise Billing; Part II” interim final rule. These changes are necessary to ensure that the IDR process recognizes congressional intent and considers a variety of factors before determining the appropriate payment. AMGA is concerned the current process inappropriately defaults to the median in-network rate, which may undermine negotiations between providers and payers. 

“CMS should recognize the danger of effectively predetermining the outcome of the arbitration process,” said AMGA President and CEO Jerry Penso, M.D., M.B.A. “By favoring a particular rate, the process could influence how payers negotiate future contracts with providers.”

In a letter to the Centers for Medicare & Medicaid Services (CMS), AMGA noted that more than 150 members of Congress shared similar concerns about the IDR process, which would essentially require the arbiter to dismiss factors such as physician training and market share in favor of the median in-network rate, or qualified payment amount, in a given area. To ensure the IRD process treats providers fairly, AMGA recommended that CMS work with stakeholders to develop a process that would be beneficial and fair to all parties.

As part of the interim final rule, CMS also is requiring providers to offer a good faith estimate (GFE) for services provided to uninsured or self-pay patients. AMGA contends the GFEs would lead to inaccuracies and confusion for patients, while adding a tremendous burden on providers’ administrative and non-clinical staff. Pausing the implementation of GFEs is necessary to allow for a rulemaking process that considers stakeholders’ input.

The letter is available here.

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About AMGA
 AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.

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Media Contact:

Sharon Grace
Chief Communications Officer
703.838.0033 ext. 393
sgrace@amga.org
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