Hospital, physician groups sue feds over surprise-billing provision

Associations representing hospitals and physicians are suing the federal government over the independent dispute resolution process outlined in CMS' surprise-billing rule. 

The American Hospital Association, American Medical Association, Reno, Nev.-based Renown Health, Worcester-based UMass Memorial Health and two physicians based in North Carolina filed the lawsuit Dec. 9. 

The lawsuit challenges the dispute resolution process outlined in the rule released Sept. 30 by CMS. The groups allege that the process, which requires arbiters to first consider the health plan's median in-network rate as the appropriate reimbursement amount, unfairly favors health plans.

"The skewed process will ultimately reduce access to care by discouraging meaningful contracting negotiations, reducing provider networks, and encouraging unsustainable compensation for teaching hospitals, physician practices, and other providers that significantly benefit patients and communities," the groups said in a news release emailed to Becker's. 

In the lawsuit, the groups argue that the dispute resolution process outlined by CMS is a deviation from what was written in the No Surprises Act, "which mandated that the arbitrator 'shall' consider all enumerated factors, without giving categorical priority to any single one."

The AHA and AMA said they are seeking to ensure there is a fair and meaningful process to resolve disputes between healthcare providers and insurance companies and that their challenge won't prevent the majority of the law from taking effect Jan. 1, 2022, the groups said.

The lawsuit was filed in the U.S. District Court for the District of Columbia and names HHS, the Labor Department, Treasury Department and Office of Personnel Management as defendants.

The AHA and AMA are asking the court to prevent the dispute resolution process from taking effect, pending judicial review of the provision.

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