Implementing the No Surprises Act

The American College of Emergency Physicians (ACEP) is deeply concerned about the Biden Administration’s interim final rule (IFR) that details how to implement the No Surprises Act. The current plan does not match the legislative text and Congress's original intention to provide an unbiased mechanism to resolve billing disputes.

The law outlines an independent dispute resolution process deliberately designed to remove patients from the middle of billing disputes and ensure a fair interaction between insurance companies and physicians to resolve any disputes. Instead, the IFR requires arbiters to prioritize an artificially low Qualified Payment Amount (QPA) set by insurance companies, rather than giving equal weight to a mix of other factors. This step undermines the entire process and could encourage insurance companies to narrow their networks even further, which would make it harder for patients to get emergency care.

Emergency physicians around the country encouraged their elected representatives to support amending the IFR as outlined in a letter from Reps. Tom Suozzi (D-NY), Brad Wenstrup, DPM (R-OH), Raul Ruiz, MD (D-CA), and Larry Bucshon, MD (R-IN) to Health and Human Services Secretary Xavier Becerra, Labor Secretary Martin Walsh, and Treasury Secretary Janet Yellen. The letter had the support of 152 bipartisan members of Congress, and it stated:

“Unfortunately, the parameters of the [independent dispute resolution] process in the IFR released on September 30 do not reflect the way the law was written, do not reflect a policy that could have passed Congress, and do not create a balanced process to settle payment disputes.” 

This policy is a gift to the insurance industry, and BlueCross BlueShield of North Carolina is already attempting to strongarm physicians. In response, ACEP and the North Carolina College of Emergency Physicians sent a letter to the North Carolina Congressional delegation urging them to reach out to the Biden Administration about the harm this policy will do to patients by reducing access to the lifesaving emergency care they need and deserve.

Emergency physicians support the goals of the lawsuit filed by the American Medical Association and American Hospital Association against the Departments of Labor, Treasury, and Health and Human Services.

ACEP joined the American College of Radiology, and the American Society of Anesthesiologists to bring a lawsuit against the federal government charging that the interim final rule on surprise medical billing goes against the language of the No Surprises Act and will ultimately harm patients and access to care.

ACEP will continue working with legislators and regulators to address this flawed rule and ensure that this legislation can accomplish what it was thoughtfully designed to do—protect patients from surprise bills without threatening access to emergency care.

 

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