Appeals court notches radiology another win in fight to fix No Surprises Act
A federal judge on Aug. 2 scored radiologists and other physicians another win in the fight to ensure proper implementation of the No Surprises Act.
The Fifth Circuit Court of Appeals ruling upholds a previous district judge’s decision to invalidate certain parts of the landmark law banning surprise medical bills. In particular, the ruling affirms that arbitrators in payment disputes should not grant extra weight to the “qualifying payment amount” calculated by insurers.
Radiologists and others had argued that independent dispute-resolution entities were placing too much emphasis on this arbitrarily calculated figure and tipping the scales in favor of insurers. The Radiology Business Management Association on Tuesday praised the ruling, calling it a “significant victory for patients and providers.”
“Large health insurance companies, driven by profit motives and fueled by unlawful IDR practices, have created barriers to care that have reduced access while adding needless burden to radiology practices and other providers,” Linda Wilgus, MBA, co-executive director of the RBMA, told Radiology Business. “This ruling supports physicians, hospitals and facilities, ensuring that patient access to quality healthcare remains a priority over insurer profits.”
The ruling comes in one of multiple lawsuits filed by the Texas Medical Association in the hopes of making the Biden administration implement the NSA as Congress originally intended. Since 2021, the association has successfully sued federal regulators four times over the law’s IDR provisions. TMA had argued in this case that the rewritten rules improperly weighted the qualifying payment amount over other factors relevant to the value of physician services.
“TMA strongly believed that tilting the scales in this manner was unfair to physicians, providers, and the patients we care for," anesthesiologist and Texas Medical Association President G. Ray Callas, MD, said in a statement. "We hope this resolves the issue once and for all: Congress intended the No Surprises Act to be a fair means of protecting patients from surprise bills. The federal agency rules must adhere to the law and cannot privilege the qualifying payment amount.”
As of Monday, only one of the association’s lawsuits remains in appeal. “TMA III” successfully challenged portions of the July 2021 interim final rules implementing the No Surprises Act, which the association said artificially deflated the qualifying payment amount. The Biden administration appealed this ruling, with a decision currently pending at the U.S. Court of Appeals for the Fifth Circuit.
You can read the full Aug. 2 ruling here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.