Update: On Thursday, Aug. 10, Senator Bill Cassidy (R-LA) sent Health and Human Services Secretary Becerra a strong letter with more than 40 questions asking for very specific information on the IDR process. These questions are informed by feedback from ACEP and others provided during a closed session Senate Health, Education, Labor, and Pensions (HELP) Committee roundtable. A detailed response has been requested by Sept. 15, and ACEP will continue following this situation closely.
In the latest win for ACEP advocacy, a Texas court has ruled in favor of physicians in one of the lawsuits filed against the government to address significant issues with surprise billing law implementation.
The decision follows months of advocacy from ACEP and allied organizations that continue to raise extensive concerns with the law’s implementation to legislators, regulators and stakeholders.
An amicus brief filed by ACEP, the American Society of Anesthesiologists, and the American College of Radiology in this case, Texas Medical Association, et al., v. United States Department of Health and Human Services et al, focused on the unlawful 600% increase (from $50 to $350) in Independent Dispute Resolution (IDR) administrative fees, and the unlawful restriction of batching claims to the same or similar service code.
The Court sided with medical associations by striking down the fee increase and the batching restrictions.
The Court rejected a request to reimburse physicians that paid the increased fee for arbitration as well as a separate request to extend the arbitration filing deadline.
Additional legal action is pending. A decision related to the inclusion of insurers’ “ghost rates” in Qualified Payment Amount (QPA) calculations has yet to be reached.
As a result of the ruling, the government has temporarily suspended the Federal IDR process, including the ability to initiate new disputes. The government will need to provide new guidance to IDR entities, providers, and insurers that reflect the new ruling. We will continue to monitor any developments and share information about relevant process changes.
On Aug. 8, ACEP issued a joint statement commending the Texas ruling.