The No Surprises Act was implemented at the beginning of this year to ensure that patients do not have to suffer from surprise medical billing expenses. The Independent Dispute Resolution (IDR) ruling within the Act governs the mediation process payers and out-of-network providers must follow when they cannot agree on reimbursement. Additionally, either party can choose to initiate the IDR process. In this week’s roundup we’re featuring three stories to help health insurers navigate this new era.
How Doctors Can Use No Surprises Act to Resolve Billing Disputes
The American Medical Association (AMA) has developed a guide for helping physicians navigate the IDR process under the No Surprises Act. The guide also discusses the resulting changes from the case filed by the Texas Medical Association. As more iterations of the legislation occur, the AMA calls for insurer accountability and transparency in hopes of protecting patients from payment disputes.
Read the full article here.
What to Look for When Selecting a Cost Containment Solutions Partner
Cost containment solutions partners can help payers navigate payments for out-of-network charges. Customer concentration, cost burdens, customer dissatisfaction, and outdated reimbursement strategies are four factors to consider when selecting a partner to help with managing costs. By assessing partners by these factors, payers are able to decide whom to trust and create a partnership with.
Read the full article here.
No Surprises Act Update – New IDR Guidance
In response to new guidance on the IDR process, the Departments of Health and Human Services, Labor and the Treasury launched two online portals– one to host the IDR process for providers and payers and one to host the patient-provider dispute resolution process for self-pay and uninsured patients. The notable difference between the prior and new guidance is removing the discussion centered around Qualifying Payment Amounts (QPAs). This removal was due to the cases brought forth by organizations such as the Texas Medical Association and the American Hospital Association.
Read the full article here.
