| Dear Members,
After years of deliberation and negotiation, Congress passed the No Surprises Act in December of 2020 to address the issue of surprise medical billing. ACEP and many others worked hard to ensure that this final product protects patients from surprise bills while providing a robust independent dispute resolution (IDR) process that ensures a level playing field for emergency physicians in their fights with insurers. Last week, the Biden Administration released its second regulation setting out how the legislation will be implemented. This interim final rule mainly focuses on the critical IDR process. As intentionally designed by Congress, the IDR process was to offer a fair interaction between insurance companies and physicians once patients are out of the middle of billing disputes. However, what this new rule puts forth is the total opposite. ACEP is disappointed and deeply concerned that the rule undermines the entire process by requiring arbiters to greatly prioritize the artificially low Qualified Payment Amount (QPA), or median in-network rate, set by insurance companies, rather than giving equal weight to a mix of other factors which were prominently emphasized in the legislation (such as complexity of the case, level of training of the physician, etc.). This approach is sure to drive payment rates lower and encourage insurance companies to narrow their networks even further, which would make it harder for patients to get emergency care. We now fear the viability of physician practices is at stake, and it will be harder for emergency physicians to care for patients, particularly in small or rural communities. The administration’s interpretation of the legislation is far outside the bounds of what Congress intended with its No Surprises Act. ACEP has already connected with the American Hospital Association, American Medical Association, and other hospital-based specialties along with other leaders to develop strategies to strongly push back against the rule. Although we are hearing from some congressional Committee staff and members of Congress who are also concerned, our greatest strength in bringing attention to this disastrous rule is you! How You Can Get Involved
Our strategy is multi-faceted and will continue to develop over the coming weeks as ACEP works hard to fight for you as emergency physicians. Please stay tuned for more updates and action you can take. Best, ,
Mark S. Rosenberg, DO, MBA, FACEP |
