Becker's Source | Comments Courtesy of Matt Zavadsky
Interesting news, especially as we get ready to start work on this issue for ground ambulance services.
Medical organizations continue to fight surprise-billing dispute process: 5 details
Alia Paavola – 1/11/2022
A coalition of medical organizations, including the Physicians Advocacy Institute and 16 state medical associations, filed an amicus brief supporting a legal challenge to the No Surprises Act dispute resolution process, according to a news release emailed to Becker's.
Five things to know:
- The groups are supporting a lawsuit filed by the American Hospital Association and American Medical Association. The lawsuit challenges the dispute resolution process outlined in CMS' surprise-billing rule released Sept. 30.
- The lawsuit alleges that the independent dispute resolution process, which requires arbiters to first consider the health plan's median in-network rate as the appropriate reimbursement amount, unfairly favors health plans.
- Specifically, the medical organizations that filed the brief Jan. 4 argue that federal regulators ignored congressional intent of the No Surprises Act by relying almost exclusively on the median in-network billing rate to resolve billing disputes instead of considering a multitude of factors.
- "Physicians have an obligation to reinforce for the court just how far federal regulators walked away from the No Surprises Act's balanced approach to resolving payment disputes and explain how bypassing the law will unfairly empower insurers at the expense of patients and their physicians," said Dustin Corcoran, president of Physicians Advocacy Institute and CEO of the California Medical Association, both of which joined the amicus brief. "If the court allows this damaging example of regulatory overreach to stand, patients and physicians will pay the price."
- There are 26 physician organizations that joined the amicus brief. Read the full list of organizations here.