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HHS Receives Its Fourth Hit From TMA

Analysis  |  By Amanda Norris  
   February 01, 2023

The Texas Medical Association (TMA) is suing HHS for the fourth time, this time for its 600% price increase pertaining to an aspect of the No Surprises Act.

That didn’t take long.

The independent dispute resolution (IDR) process has gotten more expensive for healthcare organizations, and now groups are demanding a reverse from HHS.

As HealthLeaders previously reported, it was announced that the nonrefundable administrative fee due from each party involved in any IDR payment dispute that goes to arbitration increased from $50 to $350. This 600% increase began January 1.

Revenue cycle leaders are trying to find ways to increase their bottom lines for 2023, and this news was a step in the wrong direction, especially for smaller healthcare organizations. At the time, we mentioned that this price hike may put organizations in a losing situation as they consider whether to formally dispute a payer’s proposed out-of-network payment amount.

It seems TMA agreed with HealthLeaders’ analysis as it officially filed suit against the price hike.

The TMA says its newest lawsuit against federal agencies challenges the steep administrative fee hike that will strip many physicians and healthcare providers of the arbitration process that Congress enacted. These fees are "arbitrary and capricious, contrary to the law, and in violation of notice and comment requirements," TMA said in a statement.

The initial administrative fee for the IDR process was set at $50 and it was announced in October 2022 it would remain at $50 for 2023, but in January, the agencies revealed a 600% hike in the fee due to increasing expenditures in the IDR process, among other reasons.

"The steep jump in fees will dramatically curtail many physicians’ ability to seek arbitration when a health plan offers insufficient payment for care," the TMA said.

"The problem is that many payment disputes in these cases amount to less than the fees physicians would have to pay to dispute the unfair payments," said TMA President Gary W. Floyd, MD, in a statement.

"Why would doctors and providers pay the $350 nonrefundable administrative fee to arbitrate a $200 or so payment dispute with a health insurer? The fees deny physicians the ability to formally seek fair payment for taking care of our patients, and that’s just wrong," Floyd said.

The suit lists two radiology groups as plaintiffs: the Texas Radiological Society and Houston Radiology Associated. These groups bill small value claims, so they will be particularly hurt because most claims billed are less than $350, according to the suit.

Although the fee hike takes the focus of this suit, the TMA also disputes the rules’ narrowing of the law’s provisions on “batching” claims for arbitration, which Congress authorized to encourage efficiency and minimize costs in the IDR process, the TMA said.

As mentioned, this is the fourth suit filed by the TMA regarding nuances found within the No Surprises Act. Catch up on HealthLeader’s coverage here.

Amanda Norris is the Director of Content for HealthLeaders.


The TMA's newest lawsuit challenges the 600% fee hike in the No Surprises Act IDR process.

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