The Emergency Department Practice Management Association (EDPMA)
is throwing its full support behind newly introduced legislation
aimed at supporting timely provider payments by health insurance
companies, in order to preserve our nation's healthcare safety
net.
MCLEAN, Va. ,
Sept. 13,
2024 /PRNewswire-PRWeb/ -- The Emergency
Department Practice Management Association (EDPMA) is throwing its
full support behind newly introduced legislation aimed at
supporting timely provider payments by health insurance companies,
in order to preserve our nation's healthcare safety net.
With this bill, insurance companies that
have been exploiting the No Surprises Act will finally be held
accountable.
EDPMA has long supported the patient protections in the No
Surprises Act (NSA). However, years after the NSA's implementation,
and despite clear requirements in the law itself, health insurance
companies are repeatedly failing to pay physicians within 30 days
after losing in the independent dispute resolution (IDR) process
provided in the law.
Today, a bipartisan group of legislators (Rep. Greg Murphy, M.D. (R-NC), joined by Reps. Ruiz,
M.D. (D-CA), Joyce, M.D. (R-PA), Panetta (D-CA), and Schrier, M.D.
(D-WA) as original cosponsors), introduced H.R. 9572, The No
Surprises Act Enforcement Act. With this legislation, health
insurance companies that fail to pay providers in a timely manner
after an independent dispute resolution decision will face
consequences for ignoring clear statutory obligations. The
legislation is designed to reinforce the fair and balanced process
that Congress provided in the original No Surprises Act.
Currently, with very limited enforcement and insufficient
consequences for health plans that ignore the NSA's requirements,
physician practices continue to feel significant strain from low
initial payments and later, from failure of health plans to pay the
amounts fairly awarded by an independent arbiter, even though
timely payment is required by law.
Since 1987, the Emergency Medical Treatment and Active Labor Act
(EMTALA) federal law has required that emergency physicians provide
an evaluation and stabilizing treatment for any patient that seeks
medical care, regardless of their ability to pay. Under the NSA, if
the insurer's payment for out of network clinical care is
inadequate, an emergency physician can dispute the low payment
amount through the NSA's Independent Dispute Resolution
process.
When the independent arbiter rules in favor of the physician,
the insurer is legally obligated to pay the awarded amount within
30 days. Public data indicates that approximately 80% of the time,
independent arbiters have found the physician's request to be more
reasonable than the health plan's initial payment. However, the
additional amounts owed by health plans have not been paid
consistently, or have not been paid at all, despite the clear
requirements in the law. An April
2024 EDPMA survey about the NSA, members noted that in
disputes where the provider was the prevailing party, 24% were
still not paid or were paid correctly within the 30 day requirement
in the law.
"With this bill, insurance companies that have been exploiting
the No Surprises Act will finally be held accountable," said EDPMA
Chair Andrea Brault, MD, FACEP, MMM.
"In the Independent dispute resolution process, independent
arbiters have agreed that insurers are paying providers
inordinately low rates a large majority of the time, which already
jeopardizes community-based practices and patient access to care.
We support all of the patient protections in the NSA and now, urge
Congress to hold health plans accountable for their obligations
under the law."
The proposed legislation, H.R. 9572, will require health plans
to pay interest and penalties on unpaid amounts due to providers
under the No Surprises Act.
EDPMA urges Congress to pass this bill to ensure that insurance
companies pay physicians and their practices fairly and promptly,
allowing them to continue providing essential care to their
patients.
About EDPMA
The Emergency Department Practice Management Association (EDPMA) is
the nation's only professional trade association focused on the
delivery of high-quality, cost-effective care in the emergency
department. EDPMA's membership includes emergency medicine
physician groups of all sizes, billing, coding, and other
professional support organizations that assist healthcare
clinicians in our nation's emergency departments. Together, EDPMA
members see or support 60% of all annual emergency department
visits in the country. http://www.edpma.org
Media Contact
Cathey Wise, CAE, Executive
Director, EDPMA, 817.905.3310, Cathey.wise@edpma.org,
www.edpma.org
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SOURCE EDPMA