The No Surprises Act calls for an arbitration process when an out-of-network provider takes issue with the given amount of reimbursement, according to the blog post.
Providers have long complained that the qualifying payment amount used in arbitration, and prioritized by CMS, favors insurers by incentivizing providers to lower their rates for in-network services, leaving them to either accept lower contracted rates or be forced out of network.
But in a Feb. 23 ruling the U.S. District Court in the Eastern District of Texas found that parts of the CMS proposed arbitration regulations conflict with the text of the No Surprises Act. The court removed the qualifying payment amount as the primary determining factor in the arbitration process, handing a “major victory for healthcare providers,” according to the blog post.
According to the post, which cites “multiple legal sources,” the federal court’s decision in Texas is effective throughout the country unless another court of equal or higher standing rules differently.
