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HHS Requests a Hold on Its Surprise Billing Appeal

Analysis  |  By Amanda Norris  
   May 11, 2022

After appealing the courts' ruling on vacating a piece of arbitration within the No Surprises Act, HHS asks the court for a hold on its plea.

HHS recently requested for a hold on its appeal of a Texas federal court ruling vacating parts of the independent dispute resolution (IDR) process in the surprise billing interim final rule.

According to the American College of Emergency Physicians (ACEP), HHS filed an appeal, but later asked the court to hold its appeal pending federal agencies’ release of the surprise billing final rule later this summer. The court granted HHS' request to pause proceedings while the government issues a final rule.

The ACEP, the American College of Radiology® (ACR), and the American Society of Anesthesiologists (ASA) are in favor of this hold, as the groups say they will work with CMS and other entities to ensure the final rule complies with the text and spirit of the No Surprises Act and the Texas court ruling, the ACEP said in a statement.

After HHS previously filed an appeal to the Texas court ruling, the three medical associations continued with their case to prevent insurer use of the rule's IDR process.

According to the ACEP, the groups are now pleased with the hold on the appeal and are happy that “the government is not wasting taxpayer resources to pursue its appeal of the U.S. District Court for the Eastern District of Texas decision at this time. The court's opinion affirmed that the No Surprises Act did not provide the 'give-away' to insurers enabled by the dispute resolution process published in the interim final rule.”

The original ruling sided with the Texas Medical Association, which filed a lawsuit challenging how the HHS created an arbitration process for hospitals, doctors, and insurers to settle disputes over out-of-network bills under the No Surprises Act.

The court decided that HHS was mistaken in its decision to instruct mediators to give past contracted rates between insurers and providers extra weight compared to other factors during the IDR process.

Both the Texas case and the ASA, ACEP, ACR suit impact the IDR process to determine provider reimbursement for out-of-network care. Neither case affects patient protections against out-of-network bills.

Amanda Norris is the Revenue Cycle Editor for HealthLeaders.

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