
Rethinking the No Surprises Act – Advocacy January to June 2023
The No Surprises Act has emboldened many providers and organizations to advocate for fair treatment, including these examples from its second year in effect.
The No Surprises Act has emboldened many providers and organizations to advocate for fair treatment, including these examples from its second year in effect.
Access to the federal IDR process now requires a $350 fee. Formerly $50, the 600% increase in fees has ruffled many feathers.
ACEP and EDPMA came together to express the shortcomings and outline recommendations for the NSA in a letter to HHS, Labor, and Treasury departments.
Even before the No Surprises Act’s official implementation, 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 AAOS and ASA, among others, published before 2022.
While emergency physicians perform procedures and tests based on their patient’s condition, insurance companies downcode, often based upon the final diagnoses and, in some cases, for no bonafide reason. Insurance carrier motivation is frequently just a means of reducing reimbursements.
Throughout the implementation and revisions of the No Surprises Act, the Qualifying Payment Amount, or QPA, has been the center of controversy. The insurer-controlled QPA rate allows insurance companies to underpay healthcare providers. Even with a final ruling in place, the challenges of the federal IDR process revolve around questionable practices which indirectly instruct arbitrators to favor the QPA. Learn more about the use of the QPA throughout revisions of the No Surprises Act, including the final ruling, in these articles.
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