Medical care services come at a cost. However, when the costs are heavy, the services fail to reach most people. Moreover, urban and rural health care disparity grows with such pricing arrangements.
Radiologists and many other health care service providers have raised their voices against the existing surprise billing system for a long time. Such arrangements have compelled the health care domain to function at a less than optimal level.
Discontent About Surprise Billing
The matter of surprise medical bills has bothered and enraged the radiologists to a great extent. Keeping the prevailing discontent in mind, the U.S House’s Bipartisan members have urged the administration to consider a solution. Apart from the radiologists, some other providers have also raised objections regarding this surprise billing system.
The Change In Rule Appeal
Brad Wenstrup of R-Ohio and Tom Suozzi of D-N.Y., have already started the process of circulating letters. These letters were addressed to a few agency heads and Health and Human Services. They have requested these institutions to intervene in this process. Brad and Tom have also requested the Congress members to join the cause of fighting and fixing the final rule. The existing final rule has been in work since September, 30.
Even though the lawmakers gave a nod to the No Surprise Act almost a year back, the feds did not begin the process of rulemaking until very recently. What bothers the duo is that the rule does not comply with the exact intention of Congress.
The proposed rule talks about the settlement of out-of-network payments in particular. Eventually, this arrangement places much importance on qualifying payments set by the health insurers. Qualifying payment often amounts to the median of the contracted rate of the services in particular areas.
The Consequences
The goal of the rule has been to cater to more patients seeking medical care services. However, with the existing system, the insurer might become potent enough to set the payment rates low. Therefore, chances of an insurer, benefitting from it would go up, while many patients will remain outside the circle of benefits.
Such arrangements would also reduce the expanse of provider networks. Hence, the impact of the rule would be contrary to the objective of the law. This is what the two stated clearly in their letters written to the concerned departments of HHS, Labor, and Treasury.
They further added that this arrangement could also be detrimental to the health of the reimbursement process. Consequently, the situation of current health care service disparities across the urban and rural areas would become graver.
The Way Out
Wenstrup and Suozzi suggested that the involvement of multiple factors like market share, quality of outcomes, and complexity of services might solve the problem to a great extent. They further added that factors like prior contract history between the two sides and case-mix could help settle the payment disputes. According to Wenstrup and Suozzi, the original rule directed the arbitrators to take all these factors into account.
The words of the duo often resonate with the concerns shared by several other providers. The American Hospital Association, the American Medical Association, and the American College of Radiology are some such providers.
In a news update, published on Thursday, ACR has already shared the letter to encourage speciality members to get their representatives to sign it.
If the process of implementation remains fruitful, many provider groups, including the American College Of Radiology, believe that it will set a new benchmark. The revised payment rates will certainly reduce the in-network rates as well.
Fewer or no physicians will be pushed out of the insurer’s network in the long run. Therefore, medical care services will become more accessible for all as intended by lawmakers.
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