The No Surprises Act is continuing its implementation, gradually working out all of its issues and solidifying its place in the healthcare landscape. Over the past months, we have kept you up to date with all of the twists and turns this legislation has taken, and today, we’re providing you with yet another update about the NSA’s rollout.
Last month, we mentioned that CMS planned to open an online portal for resolving payment disputes between payers and providers for specific out-of-network bills. After some delay, the portal is finally open.
CMS has been careful with the rollout of this portal, posting revised guidance that offered for independent arbiters instructions on information that must be considered before an offer is selected. Additionally, CMS released a chart that breaks down whether, in general, out-of-network services are subject to the Federal IDR process or a state law, detailed in the chart on a state-by-state basis.
If you have been following our posts about the NSA, you are most likely aware that delays and program changes are nothing new for this law. Even though the law has been in effect since January 1st of this year, the many alterations from its original draft to its eventual implementation — along with numerous final rule changes and the recent federal court ruling — have left providers and payers alike with a host of unanswered questions about the law and its surrounding programs.
CMS seems to understand this confusion. In order to clear the air and answer some of these queries, CMS has created a Frequently Asked Questions document, which can be found either using our provided link or on the CMS website. Their answers include details about new requirements and prohibitions, to whom the law applies, exemptions from the bill’s requirements, and more.
Furthermore, if a reader has questions about specifics of the implementation that aren’t found in this document, CMS offers two email addresses that can be contacted to receive additional information. Questions about new provider and facility requirements can be directed to email@example.com, while questions regarding fees and other related topics can be sent to FederalIDRQuestions@cms.hhs.gov.
If you have questions about the IDR process specifically, the American Medical Association recently put out a detailed toolkit that thoroughly breaks down the IDR process, answering many questions that payers and providers may still have.
Earlier, we mentioned a federal court ruling handed down by a Texas judge that invalidated part of the NSA specifically relating to the dispute resolution process. The Texas Medical Association originally sued the government over its interpretation of the No Surprises Act and its final rules, arguing that the scheme laid out by the final rule relied too heavily on one factor for arbiters to consider when resolving payment disputes between payers and providers. The judge sided with providers in this case, stating that there was nothing in the text of the law to indicate one factor should be weighed more heavily than any other.
Concurrently, agencies like the American College of Emergency Physicians (ACEP), the American Society of Anesthesiologists (ASA), and the American College of Radiology (ACR) filed their own lawsuits against the final rule. These lawsuits were put on hold until the ruling in the original case was decided.
Now that the case has, in fact, been decided, several events are taking place. The government is appealing the ruling, while the above agencies put out a statement saying they would continue their case against the government’s rule.
Last on our list of NSA-related updates is a recent letter sent by the ACEP and the Emergency Department Practice Management Association (EDPMA) to several federal agencies. The letter details lingering issues regarding information needed from health plans to bill patients and begin the Open Negotiations Process. As we previously noted, the first Interim Final Rule required health plans to disclose certain information to facilities and clinicians alongside the initial payment or denial. The letter claims that health plans are rarely providing all this information before offering a list of potential ways this issue and others like it can be resolved.
While this is the current status of the NSA, there is clearly still much news to come about the law. As always, we will keep you informed about the law, its impact, and its potential changes.