Insights

Rethinking the No Surprises Act: Advocacy Before 2022
Advocacy
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Rethinking the No Surprises Act: Advocacy Before 2022

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.

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danger of downcoding
Payers
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The Dangers of Downcoding

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.

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evaluation of the qpa
Payers
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Evaluation of the QPA in the No Surprises Act

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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