The ISMA has joined the AMA, other state medical associations and national medical specialty societies to seek revision of an interim final rule (IFR) that could let insurers dictate payments to physicians for disputed out-of-network charges and threaten patients’ access to care.

ISMA signed on to a letter to the secretaries of the departments of Health and Human Services, Treasury and Labor. The Nov. 17 letter argues that the provisions of Part II IFR, published on Sept. 30, do not reflect the intent of the No Surprises Act and favor insurers by benchmarking provider payments for disputed out-of-network services to the qualifying payment amount (QPA).

“Although the QPA is meant to represent the median in-network rate, the method used to calculate it (as outlined in the Part I IFR), will often result in much lower amounts,” the AMA’s summary of the IFR says. “Together, the Part I and Part II IFRs will make it more difficult for physicians to receive fair payment for out-of-network services and to enter into meaningful contract negotiations with health plans, which now have little incentive to offer fair contracted rates (especially since most insurance markets are highly concentrated).”

The AMA summary also says that “the AMA strongly disagrees with the Departments’ interpretation of the Statute as it relates to the use of the QPA in the IDR (independent dispute resolution) process and believes that the negative, long-term impact of this 'anchoring' of out-of-network rates to the QPA on independent practices, fair contracting, and eventually access to care will overwhelm any perceived benefits of this statutory interpretation.”

A copy of the AMA sign-on letter is available here. Read more from the AMA about the No Surprises Act rulemaking here.