Tag: IDR Process

NSA Implementation

Congressional Concerns: Lawmakers Challenge CMS on NSA Implementation

NSA Implementation Shortly before Congress adjourns for 2023; lawmakers sent another in a series of letters to the Centers for Medicare and Medicaid Services (CMS) expressing “serious concerns” about the implementation of the No Surprises Act (NSA). The letter accused CMS of failing to properly implement key portions of the law and suggested that the […]
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IDR resolution processing fees have been revamped

Updated IDR Processing Fees Post-No Surprises Act Lawsuit

As a result of the most recent provider lawsuit, IDR processing fees have been reworked. Since its inception on Jan. 1, 2022, the No Surprises Act (NSA) has had its growing pains, including four lawsuits challenging the process of Independent Dispute Resolution (IDR). Out-of-network services are paid for with this process when health plans, healthcare […]
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Surprise-Billing-Dispute-Resolution

Surprise Billing Dispute Resolution: Challenges, Lawsuits, and Proposed Changes

This year, the CMS has frequently halted and resumed arbitration due to court cases causing disruptions in the regulatory process aimed at settling surprise billing disputes. Summary Overview: Last Friday, the CMS finalized its revamp of the No Surprises Act resolution process, fully reopening the portal for resolving disputes, including batched and single disputes for […]
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No Surprises Act dispute resolution challenge

No Surprises Act dispute resolution challenge

The AHA and American Medical Association yesterday filed a friend-of-the-court brief in support of a Texas Medical Association lawsuit claiming the revised independent dispute resolution process for determining payment for out-of-network services under the No Surprises Act skews the arbitration results in commercial insurers’ favor in ways that violate the compromise Congress reached in the […]
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State Surprise Billing Laws for Out of Network Payment | Case Studies | AllZone Management Services Inc.

State Surprise Billing Laws Impact Out-of-Network Provider Charges

Provider charges for out-of-network care increased by $1,157 after the passage of state surprise billing laws that allow arbitrators to consider provider charges in a surprise billing dispute. State surprise billing laws that allow arbitrators to consider provider charges when determining out-of-network payment amounts for surprise medical bills led to an increase in billed charges […]
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surprised-providers-seek-changes

Surprised Providers Seek Changes to Latest Provisions of the No Surprises Act

Effective January 1, 2022, new billing protections went into effect that have the goal of providing greater protections for patients against surprise medical bills. The Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management (collectively, the Departments) implemented these additional protections that are part of the No Surprises Act […]
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