Rethinking the No Surprises Act – Advocacy January to June 2023

Group of Doctors Practicing Physician Advocacy

Numerous physicians and physician organizations have urged for an improved IDR process since the No Surprises Act was passed, as it favors insurers in its current state. Here are some examples of physician advocacy from 2023.

 

We commend The American College of Emergency Physicians (ACEP) and the Emergency Department Practice Management Association (EDPMA) as they continue physician advocacy surrounding issues with the implementation of the No Surprises Act.

In this letter to the U.S. Departments of Health and Human Services, Labor, and Treasury from January 19th, the organizations express the costly and time-consuming administrative back-and-forth revenue cycle management staff find themselves in after emergency care is administered.

On top of that, the letter outlines one physician group’s experience in which it has not received payments for more than 90% of cases – where the IDR entities ruled in its favor in all of these cases.

The groups offered valuable suggestions for immediate action, including enforcing lower fees for providers and penalties for insurers who don’t pay up after the IDR process. They also suggest re-evaluating batching to create fewer larger claims, rather than many small ones.

 

The American College of Emergency Physicians, along with over 30 healthcare associations and advocacy groups, are urging President Joe Biden to prioritize finding solutions to overcrowded emergency rooms, according to this article on Healthcare Dive.

 

ERs hold patients until beds become available in congested waiting rooms, a practice called emergency room boarding. Patients suffering and even passing in holding patterns has become a problem across the country – especially in communities with less access to care.

Their letter asks: “If the system is already this strained during our ‘new normal,’ how will emergency departments be able to cope with a sudden surge of patients from a natural disaster, school shooting, mass casualty traffic event, or disease outbreak?”

As previously predicted, the No Surprises Act is one factor leading to the overcrowding of emergency departments. Its impact on congestion is likely to grow.

 

In a win for emergency physician advocacy, CMS issued revised guidance and completely reopened the IDR process on March 17th, taking into account the recent Texas Medical Association Court Order.

This guidance removes the flawed “double counting” provision. It requires arbiters to consider all evidence presented to them by the disputing parties, without weighing the QPA more heavily than any other factor or assuming that other factors are already incorporated into the QPA.

We commend the American College of Emergency Physicians, EDPMA, and other organizations that have rallied for these changes with their physician advocacy.

Allia Group also fights to level the playing field for emergency medicine providers. Learn more about what we do to improve the revenue cycle and contact us to start recovering emergency practice revenue.

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