ACR, other doc groups call for quick end to latest surprise-billing suit in new court filing
The American College of Radiology and two other physician groups are calling for a swift end to the latest lawsuit related to the federal ban on surprise medical billing.
In a Feb. 21 court filing, ACR asked a federal judge in Texas to reach a summary judgment in the court case, avoiding a full trial. Docs believe that recent guidance from the federal government will make the mechanism for settling payment disputes with insurers “economically infeasible for most physicians.”
ACR et al. highlighted a 600% increase in the nonrefundable administrative fee for handling such quarrels, leaping from $50 to $350. Physicians also are irked that the guidance limits “batching,” or grouping together of similar claims, to those with the same CPT code.
“This distorted implementation of the [No Surprises Act] will suppress provider challenges to inadequate reimbursement when a [qualifying payment amount] is not reflective of the fair market value of items and services furnished by out-of-network providers,” ACR, the American College of Emergency Physicians and the American Society of Anesthesiologists wrote in an amicus brief. “Further, the unnecessarily limited batching of claims does not rectify the defects of the absurdly high administrative fee. Put together, the administrative fee and the limited batching criteria disincentivize providers from challenging low out-of-network rates, which will empower insurers to reduce their in-network rates significantly or terminate in-network agreements altogether.”
The Texas Medical Association filed its third and fourth lawsuits over the No Surprises Act in November and January, respectively. Provider groups including ACR hailed key victory on Feb. 6 after a federal judge ruled that parts of the independent dispute resolution process in the Surprise Billing rule violate the Administrative Procedure Act.
In a Thursday news update, ACR noted that the court has set an April 19 hearing for both sides to argue why they should receive a favorable judgment. A federal judge’s decision is expected in the weeks following that date.
Gregory Nicola, MD, chair of the ACR Commission on Economics, further explained the latest on this legal battle (and why it matters to the specialty) in a Feb. 23 blog post.
“Staff continues to monitor instances of unscheduled payer efforts to cancel/renegotiate contracts relating to the implementation of the NSA,” Nicola wrote, noting that the ACR’s Neiman Health Policy Institute is conducting studies to better understand the law’s economic impact. “We stand more than 140,000 physicians strong through coalition efforts with the ACR, American College of Emergency Physicians and American Society of Anesthesiologists.”
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.