Surprise Bill

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 … [Read more...] about California Law Confirmed by DMHC as Specified State Law Under NSA

Recently the U.S. Department of Labor issued a memorandum notifying the public and interested parties that the Qualifying Payment Amount (“QPA”) “presumption” has been invalidated as the result of a Federal Texas Court’s decision in a complaint filed … [Read more...] about Qualifying Payment Amount Presumption Invalidated | IDR Rule Rewrite Expected

On February 23, 2022, a Federal Court in Texas issued a decision and final judgment that certain parts of the Interim Final Rules Part II (“Rules”) adopted under the No Surprises Act (“NSA”) are invalid.  Specifically, the Judge held that the … [Read more...] about Federal Texas Court Nixes Federal Agencies No Surprises Act Rule

The federal No Surprises Act (NSA) became effective January 1, 2022. The law is designed to protect patients from unexpected medical bills arising from emergency and most non-emergency services administered by out-of-network providers in certain … [Read more...] about Impact of the No Surprises Act on Patient Collection and Consumer Credit Reporting

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 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