Dear Emergency Physician,
The Biden Administration recently released its second regulation on the No Surprises Act, outlining how the legislation will be implemented to combat surprise medical billing. Unfortunately, the administration’s interpretation of the legislation is far outside the bounds of what Congress intended.
This interim final rule mainly focuses on the critical IDR process, which was intentionally designed by Congress to offer a fair interaction between insurance companies and physicians once patients are out of the middle of billing disputes.
However, what this new rule puts forth is the total opposite.
The rule undermines the entire process by requiring arbiters to greatly prioritize the artificially low Qualified Payment Amount (QPA), or median in-network rate, set by insurance companies, rather than giving equal weight to a mix of other factors, which were prominently emphasized in the legislation (such as complexity of the case, level of training of the physician, etc.).
This approach is sure to drive payment rates lower and encourage insurance companies to narrow their networks even further, which will make it harder for patients to access emergency care. We also fear that the viability of physician group practices is at stake, particularly in rural and underserved areas. The bottom line is that this Interim Final Rule (IFR Part 2) will make it even harder for emergency physicians to care for their patients.
