Federal Court Strikes Down Part of HHS Surprise Billing Rule
A federal court has rejected the Biden administration's interpretation of key language in the 2020 No Surprises Act, which is designed to protect against unexpected medical billing. As part of the law, which put patient protections in place last month, the Department of Health and Human Services created a mediation protocol for doctors and facilities to settle disputes with insurers over out-of-network charges. The agency directed arbitrators to give rates insurers and providers contracted with previously extra weight compared with other factors when performing mediation. A series of lawsuits by physician and hospital groups ensued. In the case lodged by Texas Medical Association, the judge agreed the administration's approach was wrong. More than 150 different legislators also argue that all factors considered during mediation should be given equal weight. Although the case played out in Texas, the decision has nationwide implications. Capstone health care analyst Hunter Hammond said that if higher courts fail to overturn the ruling or suspend implementation to accommodate the appeals process, mediations between insurers and providers will begin without the guidance the federal judge struck down.
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