Appeals court overrules radiologists’ previous win in No Surprises Act fight
A U.S. appeals court has overruled a previous radiologist win in the fight to fix federal legislation created to stop surprise medical bills.
Judges issued the decision Oct. 30, rejecting an August 2024 ruling deeming that how insurers calculate the “qualifying payment amount” is tilted in their own favor. This figure is the basis for starting negotiations between radiologists and other physicians over out-of-network payments that result in surprise patient bills.
Radiology societies celebrated the previous win over a year ago. But the U.S. Court of Appeals for the Fifth Circuit is now undoing the decision, granting payers greater leeway in determining the QPA.
This marks a rare victory for the Biden administration and federal agencies seeking to uphold the No Surprises Act. The Texas Medical Association has filed several lawsuits in the hopes of improving the NSA, but this is the first time the feds have scored a victory, Bloomberg Law noted.
TMA, Health and Human Services and the Labor Department all declined to comment to the news outlet. This Fifth Circuit ruling will allow the administration to use so-called “ghost rates” for services providers do not offer. The Texas Medical Association had argued that this would reduce payments in the QPA calculation.
Back in August 2023, the American College of Radiology expressed concern that insurers were trying to “game the system” at the expense of physician practices.
“This important ruling will bring the law back in line with what Congress intended for the No Surprises Act—protecting patients from surprise bills and creating an unbiased mechanism to resolve payment disputes between insurers and physicians,” ACR and other medical societies in 2023 when the original decision was issued in August 2023.
You can read more about the ruling from Bloomberg and the HFMA, which originally reported the news.
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.