Written with the American College of Emergency Physicians and American College of Radiology, the brief argues that parts of the July 2021 interim final rule are flawed, according to a March 25 news release from the ASA. The brief purports a court of appeals should uphold an earlier court’s judgment that invalidated the provisions, which favor the qualified payment amount when determining out-of-network payments.
The federal government is taking the No Surprises Act loss to the 5th Circuit Court of Appeals after U.S. District Judge Jeremy Kernodle disallowed several provisions related to the qualified payment amount in August 2023. The Texas Medical Association filed the lawsuit in November 2022, alleging the provisions of the rule “skew negotiations in favor of health insurers so strongly that health insurers will force physicians out of insurance networks and physicians will face significant practice viability challenges, struggling to keep their doors open in the wake of the pandemic.”
The formula conflicts with the intent of the act, the physician groups argue, by using a calculation determined by insurers rather than the fair market value of physicians. With the provision, according to the release, “payments for anesthesiology, radiology and emergency services will be undervalued by empowering insurers to lower in-network rates, which will reduce out-of-network rates.”
The move also will threaten independent practices and could lead to consolidation or closures, the release said.
