Many providers are concerned about the weight given to the qualifying payment amount, the median contracted amount for the service, during the independent dispute process. Providers are concerned the policy will incentivize payers to lower rates for in-network services.
At least eight lawsuits have been filed opposing certain aspects of the No Surprises Act as of June 2022. One overturned the CMS arbitration process for determining payment for service by an out-of-network provider, but the outcome of the case is awaiting a revised final rule expected this summer.
Additionally, the independent dispute resolution portal did not allow submissions until April 15, Mr. Mira wrote. Providers who have attempted to embark on the process have been met with significant delays.
Mr. Mira expects further clarification on these processes, he wrote. In August, HHS released technical assistance for independent dispute resolution entities. These guidelines, which provide “more in-depth direction to certified IDR entities,” can be found here.
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