Blog

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 […]

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 […]

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 […]

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 […]

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 […]

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 by Texas Medical Association (“TMA”) et. al., against U.S. Departments of Health and Human Services HHS and […]

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 “presumption” that the Qualifying Payment Amount (QPA) is the appropriate out-of-network rate, unless credible […]

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 settings, and it prohibits providers from balance billing patients under these circumstances.  It also protects patients from paying more than […]

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 claims subject to the NSA through negotiations and the Independent Dispute Resolution process. The healthcare industry unanimously agrees that […]

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 services from out-of-network providers at in-network facilities unless notice and consent is obtained prior to the services being rendered. The […]

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 becomes effective for plan years starting on or after January 1, 2022. Under the NSA, out-of-network providers […]

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 Act? As previously written about, the No Surprises Act (NSA) goes into effect for virtually all health […]