Following a multi-year collaboration between bipartisan lawmakers and stakeholder organizations, Congress included the “No Surprises Act” in its 2020 year-end legislative package (Consolidated Appropriations Act, 2021, P.L.116-260). This act will protect patients from “surprise” medical bills and establishes a mechanism to resolve payment disputes between physicians and insurers.
Given the complexities associated with this issue, Congress and stakeholders are closely monitoring implementation of the law. To assist in this process and formally reiterate the congressional intent associated with several provisions of the act, 97 bipartisan lawmakers sent a letter June 17 to leaders of the three agencies charged with implementing the law: Secretaries Becerra (U.S. Department of Health and Human Services), Yellen (U.S. Department of Treasury) and Walsh (U.S. Department of Labor).
The letter urges the agencies to accurately reflect congressional intent throughout the rulemaking process and highlights two main tenets of the bill: keep patients out the middle and incentivize parties to act in good faith to resolve payment disputes. In cases where payment disputes remain unresolved, the law establishes an independent dispute resolution (IDR) process.
The letter also noted that the act purposefully prevents use of artificially low payment rates designed to keep providers out of network and reiterated that “implementation of the law should ensure an IDR process that captures the unique circumstances of each billing dispute and does not cause any single piece of information to be the default one considered.”
The American College of Radiology® applauds the bipartisan signatories and will continue to engage Congress and the Biden administration to ensure intended implementation.
For more information about the congressional letter and surprise billing, email Megan Marcinko, Director, ACR Government Relations.