Hospitals to Cabinet: No Surprises Act needs more flexible timing & claims batching

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The Federation of American Hospitals sent a letter Aug. 5 to the secretaries of the U.S. Treasury Department, Labor Department and HHS, in which the group outlined its recommendations for the upcoming implementation of the No Surprises Act.

The No Surprises Act, a measure to end surprise medical bills for emergency and scheduled care, was passed in December when then-President Donald Trump signed a $1.4 trillion year-end spending bill into law. 

In July, CMS unveiled an interim final rule addressing several provisions in the No Surprises Act. Most provisions outlined in the proposed rule will not take effect until Jan. 1, 2022. 

The rule details how payments from health plans to providers will be determined. It appears to keep payment rates lower than those lobbied for by hospitals and other healthcare providers.

Under the rule, the qualifying payment amount — which serves as the basis for calculating patients' share of their bills — will be based on health plans' median contract rate for similar services in a geographic area. If health plans and hospitals disagree about how much a physician or provider should be reimbursed, arbitrators will step in.

In their letter, the FAH said the the amount of payment determined in the informal dispute resolution process "should, in most cases, differ from the qualifying payment amount in light of Congress’s requirement that the IDR entity consider a robust range of relevant factors beyond the QPA and the importance of factors in this determination."

The FAH urged the secretaries to give hospitals and payers 30 days to initiate the IDR process following the initial 30-day negotiation period, instead of the four days outlined in the interim final rule. The group also called for more time to choose an IDR entity, saying the three-day timeline outlined in the interim rule is too restrictive.

The group also called for the rule to be more flexible on batching medical claims together when they are related to the treatment of similar conditions. 

The FAH argues instating these flexibilities will help prevent IDR inefficiencies and backlogs.

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