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
Surprise Bill
Plaintiffs Challenging the No Surprises Act Implementation Rules Find Support from the Industry and Most Notably Members of Congress
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
NY Moves to Amend State Surprise Bill Law, Will Other States Follow Suit?
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?
Why so much controversy surrounding the No Surprises Act, Qualifying Payment Amount?
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?
Healthcare Heavyweights File Lawsuit Over No Surprises Act IDR/QPA Rules
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
Challenges to the No Surprises Act’s Interim Final Rules, Part II, Fall on Deaf Ears
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
What’s So Great About Being An In-Network Provider Under the No Surprises Act
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
Enforcement Provision of the No Surprises Act (NSA) Proposed Rule Issued
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
Does State Law Now Preempt ERISA Under The No Surprises Act (NSA)
The No Surprises Act (NSA) becomes effective on January 1, 2022 and will apply to virtually all commercial medical claims covered by ERISA, Non-ERISA, self-insured and fully insured plans for (1) emergency care performed by an out-of-network … [Read more...] about Does State Law Now Preempt ERISA Under The No Surprises Act (NSA)
Will the No Surprises Act be Implemented as Lawmakers Intended?
Xavier Becerra, Secretary of the U.S. Department of Health and Human Services (HHS) recently informed the House Appropriations Committee that he would be seeking feedback from stakeholders before enacting a policy to end surprise billing although he … [Read more...] about Will the No Surprises Act be Implemented as Lawmakers Intended?
Finding the Sweet Spot Under Surprise Bills
Congratulations to the Cohen Howard Surprise Bill team who recently handled a New Jersey Surprise Bill claim for our client, an out-of-network plastic surgeon. Following submission of our arbitration brief, the arbitrator determined our client’s … [Read more...] about Finding the Sweet Spot Under Surprise Bills
Out-of-Network Arbitrations Yield Favorable Results For Providers
The New Jersey Department of Banking and Insurance (‘DOBI’) has published statistics tracking the number of Surprise Bill cases submitted to Maximus Federal, the DOBI contractor handling arbitration cases under the New Jersey Out-of-Network Consumer … [Read more...] about Out-of-Network Arbitrations Yield Favorable Results For Providers