WASHINGTON, D.C. (December 7, 2021)—In its formal comments to regulators on the process for resolving out-of-network medical billing disputes, the American Association of Orthopaedic Surgeons (AAOS) strongly urged the Departments of Health and Human Services, Labor, and Treasury, as well as the Office of Personnel Management to revise the regulations to be more closely aligned with the No surprises Act. It re-emphasized alarm by the deviation from congressional intent and government overreach of the Requirements Related to Surprise Billing; Part II Interim Final Rule (IFC), which takes effect Jan. 1, 2022 and will negatively impact an already strained health care system.
Rather than creating a fair and comprehensive process for physicians and insurers to settle payment disputes in a way that protects patients, the rule as-written tips the scale in insurers’ favor. It makes the insurer-formulated Qualifying Payment Amount—calculated as the median in-network rate—the presumptive appropriate payment amount as opposed to equally considering a range of factors that impact payment as intended by the law.
“Not only is this a significant departure from congressional intent, it conveys to physicians that the government is willing to emphasize cost-saving measures targeting front-line physicians above patient safety and access when it comes to solving the issues that concern the health care system,” wrote AAOS President Daniel K. Guy, MD, FAAOS in the letter.
AAOS pointed out that a common reason physicians are out-of-network is because insurers offer contract rates which are untenable to cover the true costs of care. The rule will only exacerbate the problem by creating an ad-hoc system of benchmarking which guarantees every patient in-network cost-sharing and in-network payment to physicians, while shutting physicians out of an independent dispute resolution process that accounts for their work and expertise in a meaningful way.
Additional areas of the rule that AAOS addressed in its comments include: details of the independent dispute resolution process, unintended consequences of providing the good faith estimate to patients, physician-patient dispute resolution process for uninsured and self-pay patients, and the burdens of this process on underrepresented communities.
“We strongly urge the Departments to update the IFC to reflect the statutory language and intent of the law,” continued Dr. Guy in the letter. “It is imperative to the continued practice of medicine in the United States that these consumer protections ensure both patients’ access to care and the financial health of their physicians.”
Read AAOS’ full comment letter on the IFC here: https://www.aaos.org/globalassets/advocacy/issues/surprise-billing-part-ii-letter-aaos_final.pdf
About the AAOS
The American Association of Orthopaedic Surgeons (AAOS) Office of Government Relations promotes and advocates the viewpoint of the orthopaedic community before federal and state legislative, regulatory, and executive agencies. Based in Washington, DC, with additional staff in the Academy’s headquarters in Rosemont, Illinois, the Office of Government Relations identifies, analyzes, and directs all health policy activities and initiatives to position the AAOS as the trusted leaders in advancing musculoskeletal health.
For more information on all AAOS advocacy efforts, visit http://www.aaos.org/dc
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