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Major Associations Back TMA's Latest No Surprises Act Fight

Analysis  |  By Amanda Norris  
   February 06, 2023

Several associations have filed an amicus brief backing the Texas Medical Association's (TMA) latest suit against HHS.

The TMA recently filed a suit against HHS after the nonrefundable administrative fee for participating in the independent dispute resolution (IDR) process jumped from $50 to $350—a 600% increase.

Now, The American College of Emergency Physicians, American College of Radiology, and American Society of Anesthesiologists are showing support to the TMA as the groups filed a joint amicus brief with the court.

The groups say the issues outlined in the TMA’s suit hinders physicians and facilities from engaging in fair contracting negotiations with insurers, which could threaten their ability to operate and may result in patients losing access to in-network care.

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 amicus brief also outlined the flawed qualifying payment amount (QPA) process.

The medical societies say the methodology for calculating the QPA artificially deflates the QPA by:

  • Establishing each contracted rate as a single data point
  • Excluding incentive-based and retrospective payments
  • Including rates for physicians in different specialties
  • Allowing third-party administrators to determine the QPA based on contracted rates recognized by all self-insured group health plans administered by the third-party administrator

"The inaccurately calculated QPA compounds the defects of the biased IDR process under the August final rule, which favors the QPA and empowers insurers to significantly reduce their in-network rates or terminate in-network agreements altogether," the groups say.

Amanda Norris is the Director of Content for HealthLeaders.

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