Medical societies representing radiologists, emergency physicians and anesthesiologists on Tuesday jointly praised a key court decision tied to surprise medical billing.
United States District Judge Jeremy D. Kernodle issued the order Aug. 3, vacating the “exorbitant” 600% fee increase for physicians accessing the independent dispute resolution process under the legislation.
The three societies said they applaud the ruling and are now awaiting guidance on how physicians should resolve reimbursement disputes with health insurers during this period of limbo.
“[The American College of Radiology, American College of Emergency Physicians, and American Society of Anesthesiologists] stand ready to work with the federal government, patient groups and other stakeholders to find solutions that ensure a fair IDR process for out-of-network care payment that is sufficiently accessible, can ease growing case backlogs and will help safeguard patient access to care,” the groups said Aug. 8.
They emphasized that the ruling does not impact patient protections spelled out in the No Surprises Act, which the societies “advocated for and continue to support.” Nor will it raise healthcare consumers’ out-of-pocket costs in any fashion.
District court Judge Kernodle’s ruling sided with plaintiffs the Texas Medical Association, the Texas Radiological Society and Houston Radiology Associated. TMA has filed a series of suits challenging the No Surprises Act, with the latest targeting the nonrefundable administrative fee to contest payments, along with restrictions against “batching” together similar claims. CMS increased the amount from $50 to $350, which has precluded radiologists and others from participating, given that many of their claims are under $350, the societies noted.
“Physicians, who are forced to utilize the IDR process because of unreasonable insurance payments, are prevailing in the arbitrators’ decisions more than 70% of the time. The court’s ruling is an important step in ensuring that the dispute resolution system is accessible and fair, as envisioned by the law’s authors,” ACR, ACEP and the ASA said.
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.