Lawmakers seek to penalize payers that refuse to reimburse radiology claims under NSA

Bipartisan members of the U.S. House and Senate are proposing legislation that would punish payers that refuse to reimburse claims for out-of-network healthcare services. 

Lawmakers on Wednesday officially introduced the No Surprises Act Enforcement Act. They note that the landmark surprise-billing legislation was signed into law in 2020, helping settle disputes between insurers and physicians while protecting patients from receiving unexpected medical bills. 

The NSA does so through an “independent dispute resolution” process, tasking an outside party with arbitrating arguments. However, providers have reported problems with insurers refusing to pay up following IDR rulings. 

"Nearly five years ago, the bipartisan No Surprises Act was signed into law to eliminate surprise medical billing," Rep. Greg Murphy, MD, R-N.C., said in a statement July 24. "Although this historic legislation became law, big insurance companies have not been held accountable for paying what they owe. My bill cracks down on those that are willfully defying the law and doubles down on protecting patients.”

The legislation proposes “closing enforcement gaps” by increasing penalties for not complying with payment deadlines. In addition, it would increase transparency around reporting requirements, among other updates. Murphy and colleagues in the House previously introduced the same legislation in September, but it failed to pass. 

CMS had received over 16,000 complaints under the No Surprises Act as of June 2024, according to data released last year. Top complaints against health plans 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.

“As an emergency physician, I’ve seen how delayed payments to providers hurt patients in underserved communities,” added bill co-sponsor and Rep. Raul Ruiz, MD, D-Calif. “The No Surprises Enforcement Act will ensure accountability for both insurers and providers, so health officials can enforce the law effectively and patients can receive timely, uninterrupted care.” 

The American College of Radiology, American College of Emergency Physicians and the American Society of Anesthesiologists all voiced support for the bill when it was proposed last year. The three medical societies have banded together in recent years to advocate on policy issues related to surprise billing. Radiology and emergency medicine were the two specialties with the highest volume of resolved cases under the NSA, accounting for about two-thirds of all determinations in 2024, according to a recent Health Affairs study. 

Reps. Jimmy Panetta, D-Calif., John Joyce, MD, R-Pa., Bob Onder, MD, R-Mo., and Kim Schrier, MD, D-Wash., also are sponsoring the House bill. Sens. Roger Marshall, MD, R-Kan., and Michael Bennet, D-Col., introduced the companion legislation in the Senate.