The No Surprises Act (NSA) took effect January 1, 2022. This Federal legislation requires out-of-network providers to navigate new rules and adhere to specific timeframes in order to protect their rights to challenge under-reimbursed or denied … [Read more...] about Underpayment is a Major Concern for EDs under the NSA
As we welcome in 2022, the much-anticipated federal legislation, the No Surprises Act, has officially gone into effect to protect patients from surprise bills when receiving certain medical services mainly emergency care and non-emergency care … [Read more...] about Plaintiffs Challenging the No Surprises Act Implementation Rules Find Support from the Industry and Most Notably Members of Congress
The NY Department of Financial Services (DFS) recently announced it is amending the NY surprise billing law to “apply federal requirements to the NY IDR process.” As previously reported, in 2020, Congress adopted the No Surprises Act (NSA) which … [Read more...] about NY Moves to Amend State Surprise Bill Law, Will Other States Follow Suit?
What is the Qualified Payment Amount (QPA) and why is there so much controversy surrounding the interim rules announced by the departments with regard to its application in the Independent Dispute Resolution (IDR) process under the No Surprises … [Read more...] about Why so much controversy surrounding the No Surprises Act, Qualifying Payment Amount?
As previously indicated, several lawsuits have been filed challenging the rules under the No Surprises Act regarding the presumption for Independent Dispute Resolution (arbitration) that the Qualified Payment Amount (QPA), the median in-network … [Read more...] about Healthcare Heavyweights File Lawsuit Over No Surprises Act IDR/QPA Rules
Concerns About the Federal No Surprises Act: Interim Final Rules According to an article published by KHN, the federal agencies responsible for issuing the regulations for the implementation of “the No Surprises Act” (NSA) have publicly … [Read more...] about Challenges to the No Surprises Act’s Interim Final Rules, Part II, Fall on Deaf Ears
For years, insurance companies have operated networks of physicians and facilities which they pair with company benefit plans and their own insurance policies to facilitate “in-network” coverage for members. Physician networks are marketed by … [Read more...] about What’s So Great About Being An In-Network Provider Under the No Surprises Act
The Women's Health and Cancer Rights Act (WHCRA), passed by Congress in 1998 and adopted as part of the Employee Retirement Income Security Act (ERISA), was enacted to protect women from abuses related to health plan coverage for a mastectomy and … [Read more...] about Breast Reconstruction and the Women’s Health and Cancer Rights Act (WHCRA)
The Departments of Health & Human Services (HHS), Labor, and the Treasury together with the Office of Personnel Management (OPM) issued, on September 10, 2021, a second set of regulations under the No Surprises Act (NSA). The proposed rule … [Read more...] about Enforcement Provision of the No Surprises Act (NSA) Proposed Rule Issued
At face value, it seems logical that insurance companies are responsible for paying health benefit claims. But are they? Determining the entity responsible for paying claims requires an understanding of how health benefit plans are structured and … [Read more...] about Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part IV: Know Who Is Paying Your Claim?