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ACR, ACEP, ASA File Amicus Brief Supporting Surprise Billing Implementation Suit
Feb. 23, 2023
The American College of Radiology® (ACR®), American College of Emergency Physicians (ACEP) and American Society of Anesthesiologists (ASA) filed a joint amicus brief with a Texas federal court Feb. 21 in support the Texas Medical Association (TMA) suit challenging the government’s implementation of the No Surprises Act (NSA). The brief states that the government’s 600% administrative fee increase to enter the independent dispute resolution (IDR) process, as allowed by the NSA, restricts providers’ access to this tool to obtain fair compensation for physician services. The Texas Radiological Society and Houston Radiology Associated are co-plaintiffs in this most recent TMA lawsuit.
In their joint amicus brief, the medical societies contend that fee guidance published by the Centers for Medicare and Medicaid Services on Dec. 23 increasing the non-refundable administrative fee from $50 to $350 renders the IDR infeasible for many providers whose billed services are less than $350 the vast majority of the time, particularly radiologists. In addition, interim final rules (IFR) published in October 2021 limit the batching of claims for the IDR process to “the same or similar service codes.” This means that only claims for the same code, billed to the same insurance plan within a 30-day period may be batched, further limiting IDR access. The societies asked the court to invalidate the provisions of the October 2021 IFR and the December fee guidance that unlawfully restrict access to IDR. The court has set an April 19 hearing for the plaintiffs and government to argue why each party should receive a favorable judgment. The court then will decide the matter within the following weeks.
The Texas case does not in any way impact or undermine the important patient protections included in the No Surprises Act, which ACR, ACEP and ASA advocated strongly for and continue to fully support, nor does it raise patient out-of-pocket costs.
For more information, contact Katie Keysor, ACR Senior Director, Economic Policy.
In their joint amicus brief, the medical societies contend that fee guidance published by the Centers for Medicare and Medicaid Services on Dec. 23 increasing the non-refundable administrative fee from $50 to $350 renders the IDR infeasible for many providers whose billed services are less than $350 the vast majority of the time, particularly radiologists. In addition, interim final rules (IFR) published in October 2021 limit the batching of claims for the IDR process to “the same or similar service codes.” This means that only claims for the same code, billed to the same insurance plan within a 30-day period may be batched, further limiting IDR access. The societies asked the court to invalidate the provisions of the October 2021 IFR and the December fee guidance that unlawfully restrict access to IDR. The court has set an April 19 hearing for the plaintiffs and government to argue why each party should receive a favorable judgment. The court then will decide the matter within the following weeks.
The Texas case does not in any way impact or undermine the important patient protections included in the No Surprises Act, which ACR, ACEP and ASA advocated strongly for and continue to fully support, nor does it raise patient out-of-pocket costs.
For more information, contact Katie Keysor, ACR Senior Director, Economic Policy.