Lawmakers return to Capitol Hill this month and will resume their efforts to address the problem of surprise billing. Predominantly defined as a patient receiving an unanticipated medical bill from an out-of-network provider or facility, surprise bills can be financially catastrophic for the patient. The ACR has been working with Congressional leadership and other medical societies to enact equitable legislation that will spare the patient from being part of the reimbursement equation — while ensuring that physicians and insurers continue to have the ability to negotiate fair and reasonable agreements and maintain the ability to resolve payment disputes that may arise.
The AMA sent a letter — of which the ACR was a signatory — to Congress outlining several principles that should guide lawmakers as they draft surprise billing legislation. Those principles include the following:
- Keeping patients from being caught up in out-of-network billing arrangements
- Making insurers accountable to patients by maintaining network adequacy and accurate provider listings
- Providing transparency on out-of-pocket costs to patients who may seek out-of-network care
- Benchmarking out-of-network payments to charge data rather than Medicare rates or non-transparent rates set by insurers
- Utilizing alternative or independent dispute resolution between physicians and insurers to settle disagreements over out-of-network reimbursement
- Applying any federal solutions to the surprise billing problem to all insurance plans, including the Employee Retirement Income Security Act of 1974
Many of these principles have been incorporated into state laws governing surprise billing. The ACR and other medical societies are encouraging Congress to adopt some of the more successful state models (such as those in New York and Texas) and avoid models that are not equitable to all stakeholders (such as those in California).
Engaging in the surprise billing debate is also an opportunity to realize ACR’s commitment to its Imaging 3.0® goals. One aspect of Imaging 3.0 encourages radiologists to take more ownership of their patients’ needs and expectations. Through its lobbying efforts on this issue, the College is seeking to assist Congress in drafting legislation that is first and foremost designed to help the patient by alleviating the financial burden of surprise bills. ACR’s efforts will also benefit patients by ensuring that access to imaging and other specialty services is not significantly diminished through unintended consequences borne by Congress attempting to solve this problem too quickly.
As the debate continues through the rest of 2019, I urge members to support our efforts by responding to potential calls to action requesting that you contact your lawmakers. Adding your voice will not only improve physicians’ ability to receive a more robust legislative solution, but will also relieve future burdens for the patients we serve.