WASHINGTON, D.C.— The Biden Administration has released an interim final rule (IFR) that details how the federal government will implement the legislation passed last year to protect patients from surprise bills. In response, the American College of Emergency Physicians (ACEP) said:

“Emergency physicians are profoundly disappointed that the Administration’s interim final rule (IFR) is almost entirely inconsistent with Congressional intent to create a fair and unbiased process to resolve billing disputes.

ACEP and many others worked hard with Congress to ensure a final bill that protects patients from surprise bills while providing a robust independent dispute resolution (IDR) process. The purpose of IDR is to facilitate a fair interaction between parties once patients are out of the middle of billing disputes. However, what this rule puts forth is the total opposite.

ACEP is deeply concerned that by requiring arbiters to greatly prioritize the artificially low Qualified Payment Amount (QPA) set by insurance companies, rather than giving equal weight to a mix of other factors, the new rule as written undermines the entire process. 

A true solution to surprise bills must acknowledge the role that insurance companies have in these billing disputes and recognize the root cause of the issue – narrow insurance networks.

Instead, this approach could drive rates lower and encourage insurance companies to narrow their networks even further, which would make it harder for patients to get emergency care. This approach threatens the viability of physician practices and makes it harder for emergency physicians to care for patients, particularly in small or rural communities.

We call on the Administration to enact the changes necessary to make sure this important legislation is implemented as intended. Now is not the time to take away resources from emergency physicians who are needed on the frontlines in communities across the country.”