September 19, 2023

ACR Continues Judicial Advocacy in No Surprises Act Cases

The American College of Radiology® (ACR®) filed an amicus (friend of the court) brief Sept. 18, along with the American Society of Anesthesiologists (ASA) and the American College of Emergency Physicians (ACEP) in a lawsuit filed as a result of implementation of the No Surprises Act (NSA). The lawsuit is the second challenge that the Texas Medical Association (TMA) and other plaintiffs brought against the federal government for its implementation of the act relating to the Independent Dispute Resolution (IDR) process. The process is used to decide reimbursement arguments between healthcare providers and insurers. The results of the IDR process do not affect patient costs or access to care.

The U.S. District Court for the Eastern District of Texas ruled in February 2022 that the government’s implementation of the IDR process unlawfully elevated the Qualifying Payment Amount (QPA) above other factors that an arbitrator must evaluate, such as physician skill and complexity of a patient’s case. The district court in a subsequent suit related to the QPA in February 2023 again ruled for TMA and other plaintiffs. The court invalidated — effective nationally, not just in Texas — the QPA portions of the government’s revised rule to implement the IDR process, which the court ruled still gave preference to the QPA as a primary factor in calculating reimbursement for radiology and other physician services. ACR, ASA and ACEP also supported TMA at the district court level.

The government appealed the court’s February 2023 decision to the U.S. Fifth Circuit Court of Appeals; ACR, ASA and ACEP have urged the appellate court to uphold the lower court’s decision. Our coalition’s amicus brief urges the court to consider the adverse impact of the government’s QPA rule on physician practices and patient access to needed care.

More information about the No Surprises Act is available on the ACR website. If you have questions, contact Tom Hoffman, ACR Vice President, Legal.