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Major Associations Rally in Support of TMA's Newest Surprise Billing Lawsuit

Analysis  |  By Amanda Norris  
   October 24, 2022

A handful of medical associations and groups show support to the Texas Medical Association (TMA), again. 

The TMA recently filed another lawsuit stating that the surprise billing final rule independent dispute resolution (IDR) process still fails to comply with the No Surprises Act statutory text.

The new TMA suit is filed in the same Texas Federal Court that ruled in favor of the TMA earlier this year. That ruling vacated parts of the IDR process published in the surprise billing interim final rule issued last September. 

The departments of Health and Human Services, Labor, and the Treasury officially revised the IDR process in August. At the time, CMS referenced the court decision, saying it will "remove the provisions that the District Court vacated." Now IDR entities may weigh qualified payment amounts and other factors equally in making their decisions.

This is still unjust, the TMA says, and major medical associations are showing their support for the TMA's newest filing.

The American College of Emergency Physicians (ACEP), American College of Radiology® (ACR), and American Society of Anesthesiologists (ASA) filed a joint amicus brief with the Texas court in support of the TMA. The American Hospital Association (AHA) and American Medical Association (AMA) also joined forces and filed a similar amicus brief.

According to the ACEP, ACR, and ASA, the groups will monitor the newest TMA suit and stand ready to challenge the final rule in the Northern District of Illinois if necessary.     

"Many practices, reeling from COVID-19's economic impact, cannot withstand this insurer multi-edged profit grab and may be dropped from networks. These insurer restrictions impact all care (not just out-of-network care), including cancer screenings, which plummeted during the pandemic and may yet lead to more cancer deaths," the ACEP, ACR, and ASA said in a press release.

The AHA and AMA declared a similar mindset.

"Based on their own apparent policy preferences, the Departments continue to add atextual requirements to Congress' simple framework," AHA and AMA wrote.

"Indeed, six months after this Court definitively interpreted the No Surprises Act, the Departments promulgated a Final Rule with numerous extra-statutory requirements that will interfere with a balanced consideration of Congress' mandated factors and put a thumb on the scale in favor of the QPA," the AHA and AMA said in its brief to the court.

"The severe rate cuts enabled by the Departments' insurer-friendly regulations threaten the viability of physician practices and the scope of medical services nationwide. Ultimately, the victims will be the patients who lose ready access to care."

The Texas case again solely impacts the IDR process to determine provider reimbursement for out-of-network care. The suit does not impact No Surprises Act patient protections or raise patient out-of-pocket costs. 

The AHA and AMA strongly believe that no patient should fear receiving a surprise medical bill and that patients should be kept out of the middle of any billing disputes between providers and commercial health insurance companies.

The groups say they want to see the law’s core patient protections move forward and seek only to bring the regulations in line with the law.

Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.

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