Biden Administration Publishes Additional Surprise Billing Regulations

On Sept. 30, the Biden Administration issued an interim final rule (IFR) — the third in a series to implement the No Surprises Act and curb the practice of surprise medical billing. Among other things, the IFR provides a process to settle out-of-network (OON) rates between providers and payers. The regulation establishes the federal independent dispute resolution (IDR) process that providers and plans may use to determine payment rates for OON care after unsuccessful negotiations. The IFR establishes a de facto payment rate in contravention of the law, making the median in-network rate the default factor considered in the IDR process — which will drive down reimbursement for both OON and in-network care and will likely exacerbate the problem of narrow provider networks.

Key members of Congress involved in negotiating the surprise billing law are demanding changes to the IFR before it takes effect on Jan. 1, 2022. One such letter to the Biden Administration — spearheaded by Reps. Tom Suozzi (D-N.Y.), Brad Wenstrup, DPM (R-Ohio), Raul Ruiz, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) and signed by 152 bipartisan members of Congress — points out that after extensive negotiations, Congress specifically rejected a benchmark rate.

In a press release supporting this Congressional letter, AANS/CNS Washington Committee chair, John K. Ratliff, MD, FAANS, pointed out that “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. 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.”

Click here to read the Congressional letter and here for the AANS/CNS press release.