Pathology News Roundup: June 1, 2021

Ending Surprise Billing

In a bipartisan effort, Congress is urging the HHS to implement legislation ending the practice of surprise billing and ensure its arbitration system works as lawmakers intended, aligning with policy positions supported by the College of American Pathologists (CAP).

Reps. Larry Bucshon, MD (R-IN), and Raul Ruiz, MD (D-CA), along with Sens. Bill Cassidy, MD, and Maggie Hassan (D-NH) have encouraged the administration to ensure that the No Surprises Act is implemented as Congress intended. The No Surprises Act, which included provisions advocated for by the CAP, ends the practice of surprise medical bills.

Reps. Buschon and Ruiz and Sens. Cassidy and Hassan inquired about how the new law will be implemented in a May 5 letter to Department of Health and Human Services Secretary Xavier Becerra, Department of Labor Secretary Martin Walsh, and Department of Treasury Secretary Janet Yellen. The lawmakers have sought to ensure that the government does not institute federal rate-setting and takes a balanced approach when considering arbitration factors during the dispute resolution process.

“We ask the Administration to refrain from issuing guidance or taking other action that would give preference to one factor over the other as it works to promulgate rules for the No Surprises Act,” Reps. Buschon and Ruiz said.

“The inclusion of the arbitration factors related to prior contract history and good faith efforts will show how the parties engaged prior to Congressional intervention, so as to disincentivize either party from using the process as leverage to alter rates.”

The federal lawmakers and the CAP are concerned that focused consideration on the median in-network rates could become a de facto benchmark that could spur providers to cancel contracts, which happened in states that relied only on in-network rates.

Since the bill was signed into law, the CAP has engaged in the rulemaking process to ensure appropriate implementation that will hold patients harmless, establish a fair reimbursement formula for services provided, deny insurers the ability to dictate payment, create an independent dispute resolution (IDR) process that pathologists can participate in, and require network adequacy standards for health insurers. The CAP expects regulatory proposals will be released over the next few months as the law takes effect January 1, 2022.

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