CMS Arbitration Backlog, Fee Hike Add to Labs’ Surprise Billing Challenges

In the first year following implementation of federal surprise billing legislation, the Centers for Medicare and Medicaid Services (CMS) has been overwhelmed by arbitration requests, making it difficult for providers, including clinical laboratories, to quickly challenge and resolve payment disputes.

In response to this unanticipated level of demand, CMS announced at the end of 2022 that it had raised the non-refundable administrative fee for filing a dispute from $50 per case to $350. In an email to 360Dx, a CMS spokesperson said the fee hike was deemed necessary to cover the costs of the program, noting that the law requires it be set at a level to fund the cost of administering the process for disputing parties.

For labs, though, the fee hike could impact their willingness to use the IDR process, particularly given that many lab claims are for relatively small amounts of money compared to other provider areas, said Dyana Williams, a client manager at lab consulting firm Lighthouse Lab Services.

“For a pathologist or a laboratory looking at that increased cost, $350, some services in a laboratory don’t reach that level,” she said.

https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/amended-cy2023-fee-guidance-federal-independent-dispute-resolution-process-nsa.pdf

Source: https://www.360dx.com/clinical-lab-management/cms-arbitration-backlog-fee-hike-add-labs-surprise-billing-challenges