The Texas Medical Association filed its second lawsuit in less than a year against the US Department of Health and Human Services (HHS) last month over federal policies on surprise billing.
The latest suit alleges that the recently released final rules in the government’s arbitration process between providers and payers to resolve disputed out-of-network medical bills, also known as Independent Dispute Resolution (IDR), unfairly favor insurers—despite TMA’s successful lawsuit against HHS’s interim IDR rules alleging they were biased against providers.
The 2 sides have been at odds since October 2021 over the weight of the qualifying payment amount (QPA), which the federal government included as a metric in its interim rules concerning surprise billing resolution in July 2021. The Biden administration created these rules by requirement of the No Surprises Act, which aims to prevent surprise medical billing.
The QPA is set by health insurance companies and requires the median in-network contracted rates for the same or similar service within the applicable geographic network to be used in dispute resolutions over pricing for health care services.