The California Medical Association (CMA) is calling on Congress to bolster enforcement of the No Surprises Act (NSA), a pivotal federal billing law designed to shield patients from unexpected medical bills. Visit the California Medical Association to learn more about their advocacy efforts. This law also facilitates fair payment resolutions between health plans and physicians through an independent dispute resolution (IDR) arbitration process.
Supporting HR 9572: Closing Loopholes and Increasing Penalties
To address shortcomings in the current system, CMA has joined forces with the American Medical Association and other medical organizations to advocate for the Enhanced Enforcement of Health Coverage Act (HR 9572). Introduced by a bipartisan group of representatives, including Greg Murphy, M.D. (R-NC), Jimmy Panetta (D-CA), Raul Ruiz, M.D. (D-CA), John Joyce, M.D. (R-PA), and Kim Schrier, M.D. (D-WA), this legislation aims to:
- Close loopholes that allow health plans to evade balance billing requirements.
- Increase penalties for insurers that fail to comply with timely payment provisions outlined in the billing law.
Addressing Insurer Noncompliance
Currently, insurers frequently disregard the NSA’s payment timelines, creating widespread financial challenges for physicians. Over 50% of payments owed to physicians after IDR determinations are delayed or left unpaid, despite recent reforms designed to simplify the process. This widespread noncompliance undermines the law’s effectiveness and threatens the financial stability of physician practices.
Insurers often deny coverage for care protected under the NSA and illegally alter patient cost-sharing amounts after IDR outcomes. In some cases, insurers unlawfully bill patients for the full cost of services, further increasing the financial burden on both providers and patients.
Protecting Physicians and Patients
To safeguard the goals of the NSA, CMA is urging Congress to swiftly pass HR 9572. Strengthening the billing law is crucial to ensuring that:
- Patients are protected from surprise medical bills.
- Physicians receive fair and timely compensation for their services.
- The IDR process remains equitable and effective for all parties involved.
If Congress fails to act, insurers will continue to undermine the bipartisan objectives of the NSA. This erosion of compliance threatens not only physician practices but also patient access to care across the U.S. healthcare system.
Ensuring a Balanced Future
By reinforcing the NSA through HR 9572, Congress has the opportunity to secure the financial health of physician practices and uphold patient protections. CMA remains steadfast in its advocacy to ensure that the billing law delivers on its promises, creating a more equitable and sustainable healthcare system for all.
Get Involved
Stay informed and join the effort to strengthen surprise billing law enforcement. Visit StanfordPhysicianAdvocate.org for updates, resources, and ways to take action. Together, we can protect patients and ensure fair practices for physicians.