Organized medicine sounds alarm about payer noncompliance with No Surprises Act and urges administration to increase enforcement
The AMA along with 111 national medical specialty societies and state medical associations wrote (PDF) administration officials to warn about tactics health plans are using to disregard No Surprises Act requirements and repeatedly avoid making timely payments owed to providers, forcing some practices into financial jeopardy.
The letter details how payers are misusing technical guidance to reopen closed cases, refusing to provide information that could reduce ineligible claims, not participating in mandatory negotiations, and repeatedly making late or partial payments, and, in some cases, even passing costs onto patients. The letter calls on the administration to ramp up enforcement efforts including auditing plan qualified payment amount calculations and levying penalties for late or improper payments.
Reminder: What physician office laboratories should know about the PAMA mandatory reporting period
As a reminder, the PAMA mandatory reporting period runs May 1–July 31, 2026. While most physician office laboratories (POLs) are likely excluded due to low Clinical Laboratory Fee Schedule (CLFS) revenue, some—particularly larger or higher-volume practices—may still qualify as “applicable laboratories.” POLs typically bill under the practice’s NPI, not a separate lab NPI. However, CMS determines applicability at the TIN/NPI level, meaning a physician practice may be considered an applicable laboratory if its combined lab revenues meet CMS thresholds. CMS has released a quick-reference infographic (PDF) to help POLs assess applicability. Practices that may meet thresholds should review CMS materials and ensure timely reporting.
