No Surprises Act Update August 2024

The No Surprises Act, specifically the Independent Dispute Resolution (IDR) portal portion, has seen a number of legal disputes over the last year. Recently, a federal court of appeals affirmed one of the Texas court's rulings from last year stating that the government’s rules on how to apply the No Suprises Act failed to follow the text of the law itself. Specifically, the rules gave preference to the insurer-calculated qualifying payment amount (QPA) over all other criteria when resolving payment disputes. This ruling again affirms that arbitrators must give equal consideration to all factors including the acuity of the patient and complexity of the case when resolving disputes. The newest reports on the recent outcomes of the IDR process have been encouraging for providers. Arbitrators are ruling in favor of physicians and hospitals over insurance companies in nearly 80% of the disputed cases. For anesthesiologists, the data shows arbitration awards are more than double the amount the insurance company underestimated in their submitted QPA. The ASA and other organizations continue to work to better the process and ensure providers are given a fair opportunity to present their case. The groups are pushing to add language to the final regulation that would make it a statutory requirement that insures pay physicians who prevail in the IDR process within 30 days. Seven Hills Practice Management will continue to follow the latest developments in the No Suprises Act and keep its followers apprised of any updates or changes.

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