Neurosurgeons have thrown their support behind a bipartisan letter from 152 members of the U.S. House of Representatives that calls on the Biden administration to update the interim final rule by including a key section from the No Surprises Act.
The current interim final rule, "Requirements Related to Surprise Billing; Part II," released Sept. 30, establishes a de facto payment rate, which would make the median in-network rate the default factor considered in the independent dispute resolution process, according to the letter. The legislation does not set a benchmark reimbursement amount.
The interim final rule, as structured, could incentivize payers to set artificially low payment rates, creating more narrow provider networks and reducing access to care — "the exact opposite of the goal of the law," the letter states. "It could also have a broad impact on reimbursement for in-network services, which could exacerbate existing health disparities and patient access issues in rural and urban underserved communities."
The No Surprises Act specified an independent dispute resolution process that takes patients out of the middle of payment disputes. It allows providers and payers to support their payment offers by bringing relevant information for consideration, except for billed charges and public payer data. Per this process, the letter asks the independent dispute resolution entity to consider:
- Median in-network rates
- Provider training and quality of outcomes
- Market share of parties
- Patient acuity or complexity of services
- In the case that a provider is a facility: teaching status, case mix and scope of services
- Demonstrations of previous good faith efforts to negotiate in-network rates
- Prior contract history between the two parties over the previous four years
"Congress enacted a thoughtful and balanced approach to protect patients from unanticipated medical bills for out-of-network care that also included a fair process for resolving billing disputes," John Ratliff, MD, chair of the AANS/CNS Washington Committee, said in a Nov. 8 news release. "Unfortunately, this rule directly conflicts with both the letter and intent of the law by prioritizing median in-network payment rates. It is therefore incumbent upon the Biden administration to revise the new rules before they take effect on January 1."
The Nov. 5 letter was spearheaded by Reps. Tom Suozzi, D-N.Y., Brad Wenstrup, DPM, R-Ohio, Raul Ruiz, MD, D-Calif., and Larry Bucshon, MD, R-Ind.