Lawmakers urge Trump administration to fix No Surprises Act problems plaguing radiology
House lawmakers are urging the Trump administration to fix problems with the No Surprises Act that have plagued radiology and other specialties.
Congress first passed the landmark law in 2020, enacting provisions to protect healthcare consumers from receiving unexpected bills for out-of-network care. Five years later, issues persist, resulting in a “patchwork system that fails to provide the transparency and protection for patients that Congress intended.”
Members of the House Ways & Means Committee recently penned a letter to leaders in the departments of Health and Human Services, Labor and Treasury, asking them to address such shortcomings. They highlighted a 2024 survey of emergency physicians, which indicated 24% of settled disputes were either not paid or reimbursed incorrectly 30 days after a ruling.
“We are concerned that these payment delays continue and again request further guidance that prioritizes enforcement,” Committee Chairman and Rep. Jason Smith, R-Mo., and colleagues wrote to administration leaders on Sept. 5.
CMS had received over 16,000 complaints under the No Surprises Act as of June 2024, according to data released last year. Top grievances against health plans included issuing late reimbursement after disputes were resolved and failure to conform with requirements to issue payment (or a notice of denial) within 30 days. To address this issue, lawmakers in July introduced an American College of Radiology-supported legislation, seeking to punish payers who fail to close NSA claims in a timely fashion.
In Friday’s letter, Rep. Smith and colleagues also highlighted concerns about the “qualifying payment amount,” used as a starting point for negotiations between insurers and radiologists over out-of-network claims. Lawmakers noted uncertainty around how payers calculate this key figure, “exacerbated by inconsistent regulatory actions and multiple court decisions ruling against the departments and their rulemaking guidance.”
“We request the departments finalize clear and consistent QPA calculation methodology, accelerate enforcement of updated QPA calculations, and release the statutorily mandated QPA audits to ensure transparency and accountability,” the House lawmakers wrote Friday.
In addition, the House Ways and Means Committee wants the administration to release the Independent Dispute Resolution Operations Rule, first proposed in October 2023. The rule aims to correct issues around claims eligibility and batching together of similar IDR requests, previously highlighted by W&M in years past.
“We appreciate the departments’ acknowledgment for needed improvement and stress the need for an expedited final rule to ensure an efficient IDR process for all stakeholders,” House leaders wrote.
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.