Bipartisan Congress leaders reach deal on surprise billing fix that has rankled radiologists
A bipartisan group of lawmakers has reached an agreement to address surprise medical bills, a legislative effort that had rankled radiologists and other specialists earlier this year.
Those involved include the heads of four key House and Senate committees. Under the deal, insurers will make payments to radiologists and other providers either through negotiation between the two sides, or an “independent dispute resolution process.” There would be no minimum payment threshold to enter such negotiations and claims could be batched together to help “ease administrative burdens,” lawmakers noted.
“Under this agreement, the days of patients receiving devastating surprise out-of-network medical bills will be over,” House Ways & Means Committee Chairman Richard Neal, D-Mass.; House Energy & Commerce Chairman Frank Pallone Jr., D-N.J.; House Education & Labor Chairman Robert Scott, D-Va.; Senate Health, Education, Labor & Pensions Chairman Lamar Alexander, R-Tenn., and their four ranking-member counterparts said in a joint statement issued Dec. 11. “Patients should not be penalized with these outrageous bills simply because they were rushed to an out-of-network hospital or unknowingly treated by an out-of-network provider at an in-network facility.”
The American College of Radiology noted back in February that various legislative committees had experienced a “logjam” trying to reach an agreement to address this hot-button issue. In previous comments, the college had favored such an arbitration-style approach to settling payment disputes, along with the ability to “batch” together claims to improve efficiency, both included in the announcement. ACR and others had also opposed a previous proposal that set a minimum threshold for arbitration at $750, noting that the “vast majority” of bills generated by rads fall below that amount.
In the proposed dispute resolution process, both radiologists and payers would submit an offer to an independent arbiter. The overseer would be required to consider the median in-network rate, along with info related to the training and experience of the physician, market share of both parties, contracting history, complexity of services, and any other submitted details. After the review, the entity that initiated the dispute would not be able to take the same party to arbitration over the same item or service for 90 days following the determination.
Lawmakers said they hope to attach this "important new patient protection” to the end-of-year funding package, and they’re hopeful the legislation will be signed into law in the coming days. Democratic leaders in both the House and Senate have expressed support for the legislation, the Hill reported Friday.
Over the summer, ACR, the Society of Interventional Radiology and others had urged lawmakers to keep surprise billing measures out of any future COVID-19 relief packages. At the time, they cited the “fragility” of physician practices during the economic downturn and said “now is not the time to adopt divisive” legislation.
You can read the full legislative text here, and a section-by-section breakdown 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.