The groups say that 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.
The American College of Emergency Physicians, American College of Radiology, and American Society of Anesthesiologists, are suing the federal government, saying that the interim final rule (IRF) on surprise medical billing goes against the language of the No Surprises Act and will ultimately harm patients and access to care.
The law intends to resolve payment disputes between payers and providers through an impartial arbitration system, but the plaintiffs argue that the IRF instead "create a system that empowers profit-seeking insurance companies to strong-arm local community physician practices, narrow their provider networks and reduce access to care."
In the law that was passed, the arbiter is directed to consider all information submitted by the physician and insurer, including the median in-network rate, complexity of the case, previously contracted rates and market power of the physician and insurance company, among other things.
The law states that the qualified payment amount (QPA) could be one of many equally weighted factors considered in payment disputes.
However, the rule made the QPA the primary factor in the IDR process. The organizations say that since the QPA is "an unverified rate set by insurers," using it to settle disputes "sets an artificially low benchmark payment, for all care—whether in network or not, which may not support wider access to care—particularly in underserved areas."
This lawsuit does not impact No Surprises Act protections to hold patients harmless during insurer-provider out-of-network payment disputes and will not increase patient out-of-pocket costs. The lawsuit was filed today in federal district court in Chicago.
Earlier this month, the American Hospital Association and the American Medical Association also filed a lawsuit challenging the IFR.
In addition, a November 5, letter from Reps. Tom Suozzi (D-NY), Brad Wenstrup, DPM (R-OH), Raul Ruiz, MD (D-CA), and Larry Bucshon, MD (R-IN) urges HHS Xavier Becerra, Labor Secretary Martin Walsh, and Treasury Secretary Janet Yellen to "amend the IFR in order to align the law's implementation with the legislation Congress passed."
"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," the letter says.
The letter had an additional 125 Congressional signatories.
Alexandra Wilson Pecci is an editor for HealthLeaders.