The Association of Air Medical Services (AAMS) has filed a federal lawsuit challenging interim final regulations (IFRs) that will implement the forthcoming No Surprises Act, which aims to curb surprise medical bills, including removing patients from billing disputes between air ambulances and patients’ insurers.
One aspect of the Act is the Independent Dispute Resolution (IDR), designed to allow healthcare providers and insurers, after a period of open negotiation, to make their case for payment before an independent entity. Congress has stated that no single statutory factor should be weighted in favour during the IDR process.
However, the US Federal Government has instead focused on a single factor – Qualified Payment Amount, or the insurer’s median in-network rate for a subset of their contracts for a given service in each area.
The AAMS assert that, with QPA being the dominant factor in decision making, insurers will be able to know exactly how the IDR will resolve disputes despite open negotiations. Insurers will also be able to leverage QPA against future payments, lowering all payments over time.
Disastrous consequences to emergency air ambulance services
Cameron Curtis, President and CEO of AAMS, commented: “The fair and transparent process that we all supported is not the process being implemented. Instead, we are faced with a scenario in which a patient is in an emergency, is transported by a helicopter at the request of a trained first responder or qualified physician, and that patient’s insurer gets to unilaterally determine the amount they pay. This will have disastrous consequences for access to emergency air ambulance services.”
Curtis continued: “By building this process in favor of the payor, our healthcare systems will suffer through reduced payments for necessary services, deepening an ongoing public healthcare crisis.”
While the No Surprises Act will come into play in January 2022, earlier in January 2021, the AAMS launched a free 40-week training process for clinicians.