AMA Voices Concern Over Implementation of No Surprises Act

10/14/2021
The AMA is raising concerns about the Biden administration’s issuing of a second interim final rule (IFR) to implement the No Surprises Act in January. The IFR, which was issued on Sept. 30, employs the Independent Dispute Resolution (IDR) process that can be used to settle out-of-network payment disputes between payers and physicians and other healthcare providers in surprise billing situations.

The AMA contends that the IFR significantly undermines the fairness and independence of the IDR process by requiring IDR entities to make their decisions based on the “qualifying payment amount (QPA)” unless the provider can prove otherwise.  

Although the QPA is meant to represent the median in-network rate, the method used to calculate it as outlined in the first IFR, will often result in lower amounts. As a result of these two rules combined, physicians may not receive fair payment for their out-of-network services in situations where patients have not had an opportunity to consent, such as emergency care.  

The AMA is also concerned about the impact the rules will have on the ability of physicians to enter into meaningful contract negotiations with health plans who have little incentive now to offer fair contracted rates.