Those changes include greater oversight of payers and accuracy and transparency in how the qualifying payment amount is calculated, the AHA said in a Feb. 5 letter to HHS and the Labor and Treasury departments.
The AHA said it has urged for greater oversight of payers as it relates to the No Surprises Act, adding that it is “deeply concerning that the departments have not completed a single audit of payers when the law has been in effect for nearly two full years.”
“For example, should one of the audits conclude that a payer inappropriately suppressed its QPAs, how do the departments envision remedying this situation if hundreds (or more) IDR disputes have been impacted?” the AHA wrote.
The AHA said these delays in oversight have “contributed to a fundamentally imbalanced situation where payers are able to inappropriately withhold providers’ revenue — the revenue they need to finance patient care — knowing that the likelihood of being caught or challenged is low.”
“All of the control rests with the payer; all of the risk resides with the provider and, ultimately, the patient,” the organization wrote.
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