Since the implementation of the No Surprises Act, a variety of physician organizations have advocated for an improved IDR process, as it favors insurers in its current state. Here are some examples of advocacy from the ACEP, EDPMA, AAOS, among others, from January to June of 2022.
As the NSA is being implemented, insurers are already exploiting the IDR processes – as discussed in this article from June 2022.
American College of Emergency Physicians (ACEP) and Emergency Department Practice Management Association (EDPMA) are doing an incredible job of advocating for physicians by ensuring states have the necessary checklist of requirements to distribute to health plans, writing letters to federal agencies in support.
However, the No Surprises Act’s biased IDR process, which favors insurers, is still a major obstacle in pursuing out-of-network reimbursement. It’s unlikely to yield physicians any meaningful increase in the underpaid fees paid by insurers to out of network groups.
Allia Group offers alternative and more impactful means of adjudicating these underpayment disputes.
Douglas Lundy, the American Academy of Orthopaedic Surgeons (AAOS)’s advocacy council chair, provided on-target criticism of the No Surprises Act’s IDR process in June 2022 in this article, highlighting that its timelines are unreasonable and can result in providers being unable to use this process.
Examples include the timeline for choosing an IDR entity and for initiating IDR following the end of the open negotiation period.
His viewpoint expressing flaws with the IDR process, along with the objections of other physicians, are detailed in the article linked above.
In June, the American Hospital Association urged CMS to extend enforcement discretion for the No Surprises Act.
As we view another aspect of the No Surprises Act’s implementation for providers, there are more apparent issues that continue to benefit the insurers in the federal Independent Dispute Resolution process. Providers need to create Good Faith Estimate values for their services to properly negotiate with federal IDR entities, but they lack the technology or space to share this information as it is primarily in the hands of insurers.
Fortunately, the AHA, AMA, MGMA, and HL7 are working together to provide a system for health plans to communicate Good Faith Estimate values, as a solution for providers to overcome this obstacle since the No Surprises Act was implemented over six months ago.
The No Surprises Act’s IDR process continues to prevent providers from fighting for their reimbursements. This issue stresses the challenges of revenue recovery for out-of-network practicing physicians that provide life-saving care.
Contact Allia Group to start recovering revenue for your physician group, lost to the No Surprises Act.