Lawmakers introduce radiologist-supported bill to punish payers that fail to pony up under NSA
Lawmakers on Friday introduced a radiologist-supported bill to punish payers that fail to pony up in surprise-billing disputes.
Rep. Greg Murphy, MD, R-N.C., unveiled the No Surprises Enforcement Act on Sept. 13, joined by Reps. Raul Ruiz, MD, D-Calif., and John Joyce, MD, R-Penn. The bill would close “enforcement gaps” under the landmark legislation, increasing penalties for health insurers that refuse to issue payment after losing disputes over out-of-network care.
Murphy and colleagues' legislation comes after Medicare recently released data showing the agency had received over 16,000 complaints under the NSA. Top complaints against health plan issuers included issuing late reimbursement after disputes were resolved and failure to conform with requirements to issue reimbursements (or a notice of denial) within 30 days.
"The bipartisan No Surprises Act was a significant step forward in our efforts to end surprise medical bills. However, we now need to ensure the proper implementation of the legislation," co-sponsor and Rep. Jimmy Panetta, D-Calif. Said in a statement shared Sept. 13. “I’m proud to introduce a bipartisan bill that would increase penalties for entities that fail to protect the health and financial well-being of patients. Our bill would give the No Surprises Act the necessary strength to shield working families from unexpected medical expenses by actually enforcing the law."
In addition, the No Surprises Enforcement Act also would increase transparency in reporting requirements and provide “parity between penalties imposed against parties noncompliant with statutory patient protection provisions,” Panetta and colleagues noted. The legislation is supported by the American College of Radiology, American College of Emergency Physicians and the American Society of Anesthesiologists. The three medical societies have banded together in recent years to advocate on policy related to surprise billing.
ACR et al. noted Friday that House Resolution 9572 would impose a penalty three times the difference between the insurer’s initial payment and the independent dispute-resolution entity’s ruling per claim. The amount also be subject to compounding interest.
“There is a real need for accountability after disputes are resolved under the No Surprises Act, because right now insurance companies are often just not paying,” Alan Matsumoto, MD, chair of the American College of Radiology Board of Chancellors, said in a statement. “This situation may leave clinicians in financial peril, which in turn threatens the access to care for patients that the No Surprises Act was supposed to protect. The ACR supports this legislation and its sponsors’ continued work to protect the principles of the No Surprises Act.”
“With this bill, big insurance companies that have been gaming the No Surprises Act system will be held accountable,” American Society of Anesthesiologists President Ronald L. Harter, MD, said in the same statement. “Insurers are required to make a payment after they lose in the IDR process within 30 days, which they have failed to do in many cases. This jeopardizes the sustainability of anesthesia practices, particularly small and medium sized community-based practices, and threatens the public’s access to healthcare.”
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.