3 ED physician organizations file brief to support surprise-billing legal challenge

Three organizations representing emergency department physicians filed an amicus brief Dec. 17 to support the Texas Medical Association's legal challenge to the federal surprise-billing dispute resolution process. 

The Texas Medical Association sued the Biden administration in October over what it alleges is an unfair process to resolve billing disputes between health insurers and providers. The lawsuit, filed in the U.S. District Court for the Eastern District of Texas, claims that CMS under Biden's leadership failed to follow clear direction from Congress about implementing the process to resolve reimbursement disputes.

Under the interim final rule released Sept. 30, CMS is directing the arbitrator in the independent dispute resolution process to assume that the qualifying payment amount, which is the median in-network rate set by health insurers, is the appropriate out-of-network rate.

"This creates a bias that prioritizes offers closest to the QPA, rather than allowing arbitrators to exercise their discretion to weigh all relevant factors and select the reimbursement rate that most accurately reflects fair market reimbursement and individual circumstances," the Texas Medical Association said in a news release about the lawsuit.

The three organizations supporting the Texas Medical Association's legal challenge are the Emergency Department Practice Management Association, the Texas College of Emergency Physicians and Virginia College of Emergency Physicians. 

In the brief, the three organizations argue that the dispute resolution process currently in place would have an adverse effect on the delivery of emergency care.

"With the COVID-19 pandemic, and the latest wave of new variants, emergency department safety net resources have been stretched to the breaking point," Don Powell, DO, board chair of the Emergency Department Practice Management Association, said in a news release about the amicus brief. "We see the rule leading to dire effects on the overall viability of our emergency medical care system." 

The organizations said that they strongly support the patient protections in the surprise-billing rule.

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