ACR and CAP File No Surprises Act Lawsuit

The American Academy of Radiology(ACR) and College of American Pathologists (CAP) have each filed a “No Surprises Act” lawsuit stating the interim final rule goes against the intended goal of the “No Surprises Act” and could ultimately harm patients and access to care. ACR and CAP join the list of state and national medical societies that have submitted lawsuits to change the No Surprises Act arbitration process. The lawsuit does not challenge the premise of the act which is to protect patients from surprise billing but seeks alignment between statute and the regulations for the independent dispute resolution (IDR) process. 

The Act established an IDR process where physicians and providers can settle claims disputes. There is an emphasis on using the qualifying payment amount (QPA). QPA is determined as the payor’s median contracted rate as of January 31, 2019, in the same insurance market, adjusted by the CPI for all urban consumers. There is a concern that, instead of producing market-rate physician payments, the QPA will generate an artificially low benchmark payment. 

INDUSTRY NEWS TAGS: Revenue Cycle Management

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