The Texas Medical Association extended its winning streak to four cases against the No Surprises Act last week when a U.S. District Court judge for the Eastern District of Texas issued his fourth ruling in favor of the association.

U.S. District Judge Jeremy Kernodle ruled that methodology insurers use to calculate the ‘qualifying payment amount’ — the basis for negotiations over out-of-network reimbursement ­— is “tilted in payers’ favor. The court is now disallowing several provisions related to how the QPA is determined, including incorporating ‘ghost rates’ for services that radiologists and other docs do not provide,” according to

“These provisions unfairly disadvantaged physicians in payment disputes with health insurers, ultimately robbing our patients of access to physicians’ care,” TMA President Rick Snyder said in a statement.

If it stands, Kernodle’s decision will end a status quo that allowed insurers to “game the system at the expense of community-based physician practices” and “bring the law back in line with what Congress intended for the No Surprises Act,” according to the American College of Radiology.

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