The AOA recently sent a letter of support to the sponsors of the No Surprises Act Enforcement Act, which highlighted that while the No Surprises Act (NSA) was intended to protect patients and providers from surprise medical bills, flawed implementation has created challenges. Early rulemaking overly relied on the “qualifying payment amount” (QPA), often resulting in unfairly low payments for physicians and hospitals. Additionally, insurers frequently failed to pay even when physicians prevailed in the independent dispute resolution (IDR) process, due to weak enforcement measures.
The proposed legislation would strengthen the NSA by imposing meaningful penalties on non-compliant insurers, enhancing transparency in the IDR process and ensuring physicians are properly reimbursed. The AOA emphasized that these reforms are essential to uphold Congressional intent, protect patients and hold insurers accountable.
Representatives Greg Murphy, DO (R-NC), and Lloyd Doggett (D-TX) recently introduced the Prompt and Fair Pay Act, a measure designed to bring greater balance and fairness to the Medicare Advantage (MA) program. On Aug. 13, 2025, the AOA sent a letter of support to the sponsors and to thank them for introducing this bill.
While MA plans are slated to receive a 4.33% payment increase for 2025–2026, physicians continue to face cuts under the Medicare Physician Fee Schedule and are frequently reimbursed at even lower rates by MA plans than by traditional Medicare. As enrollment in MA continues to rise, this growing gap threatens the viability of physician practices and risks limiting patient access to care.
The bill would establish a payment floor to ensure MA plans cannot pay physicians less than traditional Medicare and would require prompt payment standards to streamline reimbursements.