March 05, 2020

Physician Groups Urge Balanced Solution to End “Surprise” Medical Bills

With jurisdictional committee work having concluded in mid-February, a new phase in the efforts to resolve the issue of “surprise” medical billing has begun — leadership negotiations.

House leadership, in collaboration with committee leaders and relevant staff, had been engaged in discussions over several weeks to begin reconciling various policy approaches advanced by the House Energy and Commerce, Ways and Means, and Education and Labor committees.

In recognition of these efforts, and to help facilitate the process, a broad coalition of specialty and state-based medical societies, including the American College of Radiology® (ACR®), delivered a letter to committee leaders this week outlining several positive provisions included in the recent legislation and offering suggestions for additional improvement.

While the letter outlined details associated with several policy provisions, notable points include:

  • Avoiding references to median in-network rates as a benchmark for resolving payment disputes between providers and insurers,
  • Ensuring a robust independent dispute resolution (IDR) process by NOT establishing a required threshold to access the IDR mechanism, and
  • Providing statutory instruction that requires the arbiter to equally assess various “factors” for each dispute.

With negotiations expected to continue for several weeks, the letter should provide a comprehensive reference for congressional leaders as they work towards finalizing a policy to address this critical issue. Speaker Nancy Pelosi has articulated an interest in the House in finishing its work on “surprise” medical billing in the early part of the spring, which would allow for a period of additional negotiation with the Senate in advance of the expected May 22 deadline for health-related legislation.

The ACR Government Relations staff will continue its engagement with lawmakers on this issue and will provide additional information as it becomes available.