On Dec. 9, the American Medical Association (AMA) and American Hospital Association (AHA) filed suit against the Biden Administration to stop part of the surprise billing regulations from going into effect in January. The interim final rule (IFR) implementing the No Surprises Act requires arbitrators to primarily use the “qualifying payment amount” (QPA), which is based on median in-network rates, in deciding billing disputes over out-of-network services. However, as pointed out in the lawsuit, the statute clearly states that the arbitrator “shall” consider many factors, not just the QPA, in determining fair payments. These factors include the doctor’s experience and level of training, the complexity of the service, and prior contract history between the plan and provider.
The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) spearheaded a physician-led amicus brief, along with the Physician Advocacy Institute, supporting the AMA/AHA lawsuit. Seven national and 16 state medical societies also joined the brief. The physician organizations strongly support protecting patients from unanticipated medical bills, and neither the amicus brief nor the lawsuit challenges the patient protection elements of the rule.
Click here to read the amicus brief, here for the joint press release and here for neurosurgery’s press release.
