The first federal report on the No Surprises Act’s Independent Dispute Resolution (IDR) process reveals significantly higher dispute volumes than anticipated, along with operational challenges in eligibility determinations and resolution timelines. These early insights highlight the complexity of the IDR process and the need for more efficient strategies as payers and providers adapt to evolving requirements.
Directly on the heels of the Texas Medical Association’s (TMA’s) third lawsuit (TMA 3) challenging portions of the No Surprises Act (NSA), LifeNet, a company that provides ground and air ambulance services, has also filed their own third lawsuit (LifeNet 3).
On Wednesday, November 30, 2022, the Texas Medical Association (TMA) filed its third lawsuit challenging portions of the No Surprises Act (NSA). The latest lawsuit targets provisions of the July 2021 Interim Final Rule (“July IFR”).
MultiPlan’s Susan Mohler will present at the Texas Covered Health Care Conference, offering expert insights on navigating the No Surprises Act and helping payors adapt to evolving regulatory requirements.
The August Final Rule clarified that arbitrators need to consider QPA along with other factors such as provider experience and severity of the patient’s illness. Claritev explores whether this clarification means payors should consider adjusting the strategy they use to process surprise bills.
On Thursday, September 22, the Texas Medical Association (TMA) filed a lawsuit challenging the August 19th Final Rule of the “Requirements Related to Surprise Billing.” The suit challenges provisions concerning the way Independent Dispute Resolution (IDR) entities must treat the Qualifying Payment Amount (QPA) compared to the additional factors described in the law: training/experience/outcomes; provider and plan market share; patient acuity; teaching status/case mix/scope of services of the facility; and prior good faith efforts to contract.
Healthcare payors who believed they were prepared to comply with the No Surprises Act (NSA) without assistance have realized the new law is more complex than they initially thought. That’s the message Claritev has repeatedly received from clients who elected to try to manage the NSA or parts of it on their own.
Some healthcare payors continue to struggle to create an effective strategy to deal with No Surprises Act (NSA). In this post, Claritev offers five suggestions to help payors effectively navigate the new law.
Claritev discusses how the Texas Federal Court struck down the HHS’s interpretation of how the QPA should be used in the IDR process outlined in the NSA.
