RBMA Issues Call to Action on Surprise Medical Billing

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Arbitration provisions in proposed new laws addressing out-of-network hospital bills will ensure effective protection for patients and a fair market for radiology practices and other independent provider organizations.

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We believe that if we make our voices heard, legislators will listen to the experience of the radiology business experts among their constituents and include an appropriate IDR process in the final law

The Radiology Business Management Association is urging its members to contact their elected officials in Congress about new bills to protect patients from unexpected out-of-network medical bills incurred while receiving care at in-network hospitals. RBMA supports the bi-partisan Protecting People from Surprise Medical Bills Act (H.R. 3502), introduced in the U.S. House by Representatives Raul Ruiz, M.D. (D-Calif.), and Phil Roe, M.D. (R-Tenn.), along with 40 other co-sponsors from both parties. H.R. 3502 is similar to legislation successfully implemented in states like New York and has proven to be an effective way to protect patients from unexpected large out-of-network bills while preserving high-quality independent provider groups as a viable part of our healthcare system. It includes provisions for an independent dispute resolution (IDR) process when providers and insurers cannot agree on a patient’s cost of care—an important safeguard that keeps insurers from simply dictating the price of care to provider groups that serve hospitals, like radiology practices.

In contrast, the Senate version of surprise billing legislation— the Lower Health Costs Act (S. 1895)—does not include provisions for an IDR process. Instead, reimbursements to out-of-network providers, like many radiology practices, will be set to the average in-network rate (benchmark rate) using data supplied by insurance companies. RBMA is asking its members to contact their Senators and push for having S. 1895 amended to include an IDR process before it is voted on. Indeed, Senator Bill Cassidy (R-La.) has already proposed such an amendment and it only needs adoption. At the same time, RBMA members should also call their House Representatives and urge them to support H.R. 3502.

“RBMA members represent organizations across our country dedicated to serving patients with the high quality advanced medical imaging delivered safely and efficiently,” said Bob Still, Executive Director of RBMA. “We know what works at the state level in protecting patients from large out-of-network hospital bills while maintaining the quality and access to radiological services patients depend on. We believe that if we make our voices heard, legislators will listen to the experience of the radiology business experts among their constituents and include an appropriate IDR process in the final law.”

Unexpected out-of-network hospital billing (often called surprise billing) typically occurs when insurers contract with a particular hospital but not with all the independent physicians and provider practices that serve that hospital. As a result, hospitalized patients may discover that they must pay the difference (balance) between what their insurer pays an in-network provider and what the out-of-network provider typically charges for those services in that hospital.

“Limiting the amount patients at an in-network hospital can be billed for out-of-network services is sensible, but simply allowing insurers to dictate the rate without an IDR process as a safeguard can lead to unexpected negative consequences on patient care,” said RBMA Federal Affairs Committee Chair Linda Wilgus, CPA, MBA, FRBMA. “When crafting our national legislation, we should adopt what is known to work in the states for protecting patients from high cost surprise medical bills.”

The RBMA Federal Affairs Committee is actively engaged in Congress to advocate for legislation that protects patients from high cost surprise bills, settles disputes quickly and reasonably, and ensures that patients are provided ample in-network choices. RBMA members who would like to get involved are asked to:

  •     Contact their House representative by clicking here and asking for their support of the Protecting People from Surprise Medical Bills Act.
  •     Contacting their your Senators by clicking here and asking to replace current “benchmark” language with arbitration language as considered in the Sen. Cassidy amendment and/or House companion bill.

About RBMA

Founded in 1968, the Radiology Business Management Association is a national not-for-profit association providing members with applied business information and intelligence applicable in any radiology setting. RBMA represents more than 2,300 radiology practice managers and other radiology business professionals. Its aggregate influence extends to more than 24,000 radiologic technologists and 26,000 administrative staff and physicians. RBMA is the leading professional organization for radiology business management and is recognized for its radiology-specific educational programs, products and services, publications and data. The resources and solutions RBMA offer its members and the broader health care community are helping to shape the profession’s future.

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Daphne Gawronski
Radiology Business Management Association
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