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.
The impact of the No Surprises Act can already be felt in emergency rooms and specialty practices across the country, as physician groups must deal with the way the NSA affects their practices’ revenue streams. From bankruptcy risk to emergency service closures, here are some examples of the serious outcomes of a flawed NSA and IDR process.
With thousands more claims than expected and long wait times causing providers delays in reimbursement, It’s no surprise that the No Surprises Act’s IDR process and its serious shortcomings have caused a strain in the US healthcare system, which could lead to major repercussions. In this blog, you will find a collection of challenges providers are facing at the mercy of a slow, cumbersome IDR process.
