Surprise Bill

The No Surprises Act (NSA), enacted in December 2020, was designed to protect patients from unexpected medical bills for emergency services and certain non-emergency services provided by out-of-network providers.  A central component of the NSA is … [Read more...] about Legal Motion Filed to Rehear Fifth Circuit’s Decision on Inclusion of Ghost Rates in NSA QPA Calculation

Nearly three years after the No Surprises Act (“NSA”) became effective, there have been many surprises along the way. From the four lawsuits by the Texas Medical Association challenging the implementation of the Act, revisions to rules put forth by … [Read more...] about The No Surprises Act: A Practical Perspective

Last week, the U.S. Fifth Circuit Court of Appeals held that regulations implemented by the Departments of Health and Human Services, Labor, and Treasury were permitted to include "ghost rates"—contracted rates for services that were never actually … [Read more...] about A History of Legal Battles: The Texas Medical Association’s Multi-Lawsuit Campaign under the No Surprises Act

Late on Friday, August 2, the Fifth Circuit Court of Appeals upheld a crucial ruling in the Texas Medical Associations (TMA) II lawsuit, marking another substantial victory for out-of-network providers and the TMA.  This landmark decision affirms … [Read more...] about Fifth Circuit Upholds TMA II Decision

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 … [Read more...] about Federal Texas Court Orders Government Agencies to Vacate NSA Fee Increase and Batching Rule

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 … [Read more...] about Court Decision in TMA Lawsuit Good News for Providers

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 … [Read more...] about Federal Agencies Levy Substantial Increase in Administrative Filing Fees for NSA IDR in 2023

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 … [Read more...] about Texas Medical Association Files 3rd Lawsuit Challenging NSA Rule

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 … [Read more...] about No Surprises Act Final Rule Issued…Good News for Providers

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 … [Read more...] about No Surprises Act Remittance Advice Codes

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 … [Read more...] about Federal Departments File Notice to Appeal TMA Decision