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US SENATORS SUMMON MULTIPLAN’S CEO TO DISCUSS ALLEGED NEFARIOUS BUSINESS PRACTICES

On May 22, U.S. Senators Ron Wyden (D-OR), Chair of the Finance Committee and Bernie Sanders (I-VT) Chair of the Health, Education, Labor and Pensions (HELP) Committee issued a letter to Travis Dalton, CEO of MultiPlan.  Mr. Dalton is being called upon to address the findings from an investigation by a New York Times (NYT) […]

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NY Times Investigation Exposes Multiplan & Insurer’s Hidden Financial Incentive Practices

Last Sunday the New York Times published two articles written by journalist Chris Hamby, regarding Multiplan and the major health insurance companies. His investigation exposed the “Percentage of Savings Model”, used by Multiplan and insurers that incentivizes the parties to under-reimbursement out-of-network claims to yield higher fees for themselves: Insurers Reap Hidden Fees by Slashing […]

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Federal Texas Court Orders Government Agencies to Vacate NSA Fee Increase and Batching Rule

As previously reported, the Texas Medical Association (TMA) filed a series of lawsuits over the rules implemented by the Departments under the No Surprises Act. On August 3, 2023, Judge Kernodle, US District Court of Eastern Texas, ruled in favor of the TMA vacating certain portions of the No Surprises Act final rule. This lawsuit […]

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Federal Government Appeals No Surprises Act (NSA) TMA II Decision Concerning the QPA

In a recent development surrounding the implementation of the No Surprises Act (NSA), the United States Department of Justice (DOJ) has filed an appellate brief to appeal the Texas Medical Association (TMA) II decision. This decision vacated certain portions of the Interim Final Rules Part II which were determined to continue to prioritize the qualifying […]

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NJ DOBI Issued Bulletin No. 23-05, June 28, 2023, Non-Discriminatory Coverage for Transgender Individuals

In an effort to promote equal access to healthcare and coverage, the New Jersey Department of Banking and Insurance has published Bulletin No. 23-05 following Governor Murphy’s issuance of Executive Order 326, “Protecting Gender-Affirming Health Care in New Jersey”. This bulletin serves as a reminder to all insurance companies authorized to issue health benefits plans, […]

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Court Decision in TMA Lawsuit Good News for Providers

This week, a Texas US Federal District Court granted a summary judgement in favor of the Texas Medical Association (TMA) setting aside and vacating the latest qualifying payment amount (QPA) Rule as violating the No Surprises Act (NSA).  The Court acknowledged, “although the Departments have abandoned the ‘rebuttable presumption’ term, they have not relinquished their […]

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Federal Agencies Levy Substantial Increase in Administrative Filing Fees for NSA IDR in 2023

Late Friday afternoon on December 23, 2022 and well after most had begun celebrating their holiday, CMS quietly announced that it was increasing the non-refundable administrative fee for all IDR filings initiated under the No Surprises Act from $50 per item or service to $350 per item or service commencing January 1, 2023. The fee […]

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Texas Medical Association Files 3rd Lawsuit Challenging NSA Rule

On Wednesday, November 30, 2022 the Texas Medical Association (TMA) filed its third lawsuit against the Departments of Health and Human Services, Labor and the Treasury (the “Departments”) claiming that the final revised rule under the No Surprises Act (NSA), a federal law that aims to protect patients from surprise medical bills, continues to unfairly […]

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No Surprises Act Final Rule Issued…Good News for Providers

On Friday, August 19, 2022, the U.S. Department of Labor and related Federal regulatory agencies issued final No Surprises Act rules “only for certain issues critical to the implementation and effective operation of the Federal IDR process”. These final rules were in response to the previously reported Texas Medical Association and LifeNet court decisions1 and […]

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No Surprises Act Remittance Advice Codes

Claims subject to the No Surprises Act (NSA) regulations have, over the last few months, begun to move through the revenue cycle process with new coding and regulatory compliance applicable for these claims. In preparation, on March 2, 2022, CMS issued a list of NSA specific remittance advice remarks codes (RARCs), approved by the RARC […]

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Federal Departments File Notice to Appeal TMA Decision

Last Friday, the Defendants in the lawsuit filed by the Texas Medical Association (TMA) against the U.S. Department of Health and Human Services (HHS) and other Federal Departments, entered a notice that the federal departments collectively intend to file an appeal with the United States Court of Appeals Fifth Circuit to challenge the summary judgement […]

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California Law Confirmed by DMHC as Specified State Law Under NSA

The California Department of Managed Healthcare (DMHC) on March 21, 2022 issued an All Plan Letter with guidance to All Full-Service Commercial Health Care Service Plans clarifying the enforcement rules that apply between relevant, specified state laws, primarily AB72 and the Knox-Keene Act, and the Federal No Surprises Act (NSA). Implementation of the Federal NSA […]

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