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Pre-Payment Negotiation Is Beneficial to Payors and Providers in Settling Surprise Bills
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.
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Texas Medical Association Challenges Provisions to IDR Process
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.
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NSA’s Final Rules
On August 19th, the long-awaited final rules under the No Surprises Act (NSA) were issued. Titled “Requirements Related to Surprise Billing: Final Rules,” they finalize certain requirements that group health plans and health insurance issuers offering group or individual health insurance coverage must meet when reimbursing claims determined to be surprise bills as defined by the Act.
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Midyear Check-In with Healthcare Payors on the No Surprises Act
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.
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White Paper: Health Leaders Respond to the No Surprises Act
Claritev's recent survey indicates that healthcare payors and providers see the regulations in the No Surprises Act, which was enacted to help protect patients from balance billing, as a positive step toward protecting patients from experiencing unexpected costs.
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Infographic: Healthcare Payors and Providers Respond to the No Surprises Act
The findings illustrated in this infographic are based on a survey that polled healthcare executives, with strong familiarity with the No Surprises Act. Healthcare payors and providers agree that the NSA will help to solve some of healthcare’s largest challenges, driving innovation and collaboration.
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Five Tips to Help Payors Navigate the No Surprises Act
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.
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Texas Court Rules Arbitrators Can’t Place Higher Importance on QPA in Surprise Bill Arbitration
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.
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The Basics of the Federal IDR Portal
The No Surprises Act requires a Federal Independent Dispute Resolution (IDR) portal to be used to initiate the Federal IDR process, select an IDR entity, and submit arbitration offers. Claritev discusses the basics of this portal.
Solution: No Surprises Act Services
