ASA Leaders Urge White House OMB to Finalize NSA Rule in Call

On February 27, ASA joined with the American College of Emergency Physicians (ACEP) and the American College of Radiology (ACR) for a formal call with the White House Office of Management and Budget (OMB) to discuss the pending No Surprises Act (NSA) Operations Rule, a pending federal regulation that could improve the law’s dispute resolution process for physicians and health care providers.

During the call, ASA President Patrick Giam, MD, FASA, and President-Elect Jeff Mueller, MD, FASA, emphasized that anesthesiologists strongly support the goals of the NSA and want to remain in-network whenever possible. However, when negotiations with insurers fail—particularly in markets dominated by only one or two payers—physicians must rely on a fair, transparent, and efficient independent dispute resolution (IDR) process to secure appropriate payments. 

ASA expressed support for key provisions in the proposed Operations Rule that would streamline the process, reduce administrative burden, and improve functionality for small and medium-sized anesthesia practices. ASA specifically urged policymakers to finalize provisions that expand batching of anesthesia claims based on a payer’s conversion factor, reflecting how anesthesia services are actually contracted and paid, and to enhance portal-based processes to reduce errors and unnecessary disputes.

ASA and its partners also pressed for reforms to address operational failures that increase costs and confusion, including clearer payer reporting requirements, standardized use of CARC (Claim Adjustment Reason Codes) and RARC (Remittance Advice Remark Codes) codes, improved transparency around plan identification, and stronger participation requirements during open negotiation.  The organizations underscored that high administrative fees and restrictive batching rules should not create barriers to accessing IDR, as Congress did not intend to impose financial thresholds on the process. 

ASA will continue advocating for finalization and strong enforcement of these reforms to ensure the IDR system functions as intended—supporting fair market-based payments, protecting patient access to care, and enabling anesthesiologists and their practices to successfully navigate the dispute resolution process.