MultiPlan appointed industry veteran Liz Longo to lead its surprise bill arbitration services, strengthening its end-to-end approach to help healthcare payors comply with No Surprises Act regulations.
The 2nd Interim Final Rule for the No Surprises Act clarifies the arbitration process and the importance of the QPA.
“Baseball-style” arbitration under the No Surprises Act is designed to encourage payors and providers to reach agreement before formal dispute resolution. By requiring arbitrators to choose between final payment offers rather than splitting the difference, the process incentivizes both sides to submit reasonable proposals and settle disputes more efficiently without prolonged arbitration.
The Qualifying Payment Amount (QPA) is a central component of the No Surprises Act, representing the median in-network rate used by health plans to determine out-of-network reimbursement. Understanding how QPA is calculated and applied is critical for payors and providers navigating payment decisions and the IDR arbitration process.
Surprise billing has created significant challenges for healthcare payors, increasing costs and administrative complexity. The No Surprises Act aims to protect patients while shifting payment disputes to payors and providers, making it essential for organizations to understand its impact on reimbursement, negotiations, and the overall claims process.