Physician Billing Services Are Experiencing State-Level Disruption

The No Surprises Act has made a stir across the healthcare industry, but it might be causing the most upset at the level of physician billing services. 

The 2020 Act created a level of protection for patients (it protects healthcare consumers with private health insurance against unexpected medical bills) – AHIP reports that it’s prevented over 2 million potential surprise medical bills for American patients. But it’s also created some chaos for physicians, applying pressure around notice-and-consent requirements and good faith estimates for uninsured and self-pay patients. An MGMA survey found that 82% of practices said it increased their administrative burden, and 74% said they don’t have the tech infrastructure to comply by 2023. Physicians and physician groups around the country have filed lawsuits over the change. And some states are pushing back, too. 

The Texas Medical Association (TMA) is on its second lawsuit against the federal government regarding how it’s implemented the No Surprises Act. The TMA is making the case that the final regulations deviate from the way the law is written – essentially guaranteeing that physicians (as well as other providers) will be under-compensated by both insurers and patients. 

But Texas isn't standing alone on this. The California Medical Association (CMA) has stepped out in support of the TMA to make sure the independent dispute resolution process is still available to protect disputes for services under the Act and patient access to in-network physicians. And the AMA agrees. They recently partnered with the American Hospital Association (AHA) to be “a force multiplier”, filing an amicus brief. Here’s what they’re saying

“In the latest final rule, CMS explains that the QPA presumably already factors in most other data, and that, therefore, the IDR entity, or the arbiter, is directed not to, quote, double count or consider all other data that were required to be considered by Congress unless they find that a physician demonstrates that their data was so exceptional and unusual that it wasn't already included in the QPA calculation.”

So, what does this mean for physicians? It means that it might be time to talk to your Congressional representatives and the AMA with your perspectives. This is a lot on top of everything you’ve been doing to recover from the pandemic, but the way this Act is implemented can make a significant difference in your financial viability and the type of care you’re providing your patients. 

It will be worth keeping a close eye on medical associations in your specific state to look for opportunities to share your opinions or even get involved in deeper ways. In the meantime, it will be worth considering physician billing services to navigate stormy weather until we find a calmer future. 

Healthcare is going through a period of significant change, and physicians have a unique opportunity to shape the way we all emerge from this period in healthcare history. I hope they’ll take advantage of it.