Tens of thousands of radiologists and other doctors oppose surprise billing provision


Rather, doctors want independent arbitrators to take many factors into account when resolving disputes, as provided for in the original legislation. These could include the quality of the results, the market share, the acuity of the patient, the scope of the establishment’s services and the history of contracts between the two parties. In June, a bipartisan group of 97 House officials urged the administration to avoid giving too much weight to a single factor (including the median network rate) in pay-to-provider payment negotiations, the officials noted. groups.

Others have also spoken out against the provisional rule. The American Medical Association pointed to its own recent study, which found that 73% of the nation’s insurer markets are “highly concentrated.” This usually results in higher premiums and tighter networks, a “root cause” of this problem, WADA said.

“[The interim final rule] ignores the role of the insurance industry in creating the surprise billing problem at the expense of independent medical practices whose ability to negotiate supplier network contracts continues to erode, ”said President Gerald Harmon, MD, in a statement.

The Radiology Business Management Association, the Emergency Department Practice Management Association (representing business leaders in emergency services) and the Healthcare Business Management Association (responsible for the revenue cycle) echoed these concerns in their own joint announcement.

Meanwhile, the country’s largest trade association for health insurance companies has expressed support for the interim rule, arguing that its arbitration approach will ensure businesses and families avoid unnecessary premium increases. Americas Health Insurance Plans also believes the rule will encourage more providers to join health plan networks, according to a September 30 announcement.

“We are especially encouraged to see that the rules are consistent with the intent of the No Surprises Act and that arbitral awards must begin with a presumption that the appropriate off-grid reimbursement is the qualified payment amount,” said Matt, President and CEO of AHIP. Eyles. “This is the right approach to encourage hospitals, healthcare providers and health insurance providers to work together and negotiate in good faith. “

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