In a victory for small, independent physician and radiology practices, a U.S. Fifth Circuit Court of Appeals judge sided with the Texas Medical Association, the American College of Radiology (ACR), and other supporters over flawed independent dispute resolution (IDR) regulations issued as part of the No Surprises Act, the ACR and the Texas Medical Association announced this week.
At issue are regulations that placed the qualifying payment amount (QPA) as the first of several payment factors that arbitrators should consider in resolving physician-insurer disputes. The IDR process was a controversial part of the No Surprises Act, especially the stipulation of the QPA as the primary determinant of reimbursement.
The ACR praised the appellate judge panel's decision, emphasizing three points:
- The appellate panel agreed that TMA had legal standing to bring its lawsuit because TMA members likely would suffer financial harm through a lower, QPA-driven rate.
- The panel ruled that the regulatory departments exceeded their authority in placing a “thumb on the scale” in favor of the QPA as the first factor arbitrators must evaluate.
- The panel held that the trial court properly invalidated the revised QPA regulations nationally.
The government now must decide whether to request rehearing of this decision before the full appellate court, the ACR said in an August 8 bulletin.
