The Texas Medical Association (TMA) is now 4-0 on its legal challenges to the Biden administration’s rocky implementation of the No Surprises Act, which bans surprise out-of-network medical bills and outlines processes to resolve payment disputes between providers and payers.
In a decision filed Thursday (PDF), U.S. District Judge Jeremy Kernodle largely agreed with the association’s late 2022 objection to certain provisions of the implementation—those related to the calculation of a “qualifying payment amount” (QPA) used during dispute arbitration—that TMA had argued “unfairly disadvantaged physicians in payment disputes with health insurers.”
The No Surprises Act gives payers and providers 30 days to settle any disputes on an out-of-network charge. If an agreement can’t be reached, both parties submit a preferred amount to a third-party arbitrator, which then chooses one—a process referred to as independent dispute resolution.