AMA Submits Comment Letter to CMS on Interim Final Rule: Requirements Related to Surprise Billing

The American Medical Association (AMA) submitted comments on September 7 to the Centers for Medicare & Medicaid Services (CMS) regarding the Interim Final Rule (IFR): Requirements Related to Surprise Billing, Part 1. 

In the letter, AMA thanked CMS for establishing important patient protections in the IFR, including strengthening the standard for accessing emergency medical care to help ensure that many patients are not forced to choose between seeking care or facing financial hardships, and recognizing the impact of unanticipated out-of-network care on patients with high deductible plans.

Although the IFR puts these and other important reforms in place, the AMA said it has serious concerns with some IFR provisions. 

One of the concerns is the Qualifying Payment Amount (QPA). The AMA said it's in all stakeholders' best interest to ensure that the calculation associated with cost-sharing and surprise medical billing that purports to represent a median in-network commercial rate for provider payments in this process is truly reflective of the market. The QPA, as outlined in the IFR, does not meet that standard. Therefore, AMA urges the Departments involved to take steps to ensure the QPA is considered by the independent dispute resolution (IDR) in context, does not play an oversized role in the IDR entity's decision-making, and is approached with the understanding that the QPA was not designed to always represent a median commercial in-network rate.