|
In the latest round of
rulemaking on the No Surprises Act (NSA), the 2020 law that bans most balance
medical billing, providers won concessions from the Biden administration
regarding the calculus arbitrators must use to decide billing disputes. One
expert tells AIS Health, a division of MMIT, that the new regulation, which
takes recent pro-provider court decisions into account, is likely to reduce
the amount of cost savings the NSA generates for payers.
Payers, providers swamp
arbitrators with 46,000 disputes
- Payers and
providers between April 15 and August 11 submitted over
46,000 disputes to the federal independent dispute
resolution (IDR) portal — a number “which is substantially more than the
Departments initially estimated would be submitted for a full year,”
according to a report prepared by federal officials from the three
federal departments that administer the NSA.
- The officials
also said that “of the disputes initiated between April 15th and August
11th, certified IDR entities rendered a payment determination in over
1,200 disputes. Between April 15th and August 11th, non-initiating
parties challenged over 21,000 disputes’ eligibility for the federal IDR
process, which constitutes nearly half of all disputes initiated.”
- The new final
rule is the latest in a series of regulations issued by the Biden
administration. Payers and providers have viewed IDR regulations as a
zero-sum issue. In particular, providers have objected to the way that
the administration designed arbitration criteria, arguing that previous
regulations favored insurers at their expense.
Providers will benefit
from new rulemaking
- Loren Adler, an
economist and associate director of the USC-Brookings Schaeffer
Initiative for Health Policy, tells AIS Health that the new rule will
probably benefit providers.
- “I think the
most likely effect is that will mean that you have somewhat higher
average outcomes in arbitration, and in turn you have somewhat higher
pay for providers and higher premiums for consumers,” Adler says. “The
magnitude of that, however, is highly uncertain.”
- Adler says his
“assumption is that the magnitude of that effect is relatively small,
though non-trivial” — adding that he is “loath to venture a guess” and
has a “very wide confidence interval.”
- Providers would
like to “inject a whole host of uncertainty” in order to “capture the
process, win the day, and get this nice new government price support,”
Adler says. “This [final rule] makes that somewhat more likely, but I
still tend to think that arbitration decisions are going to generally
hew close to the QPA [qualifying payment amounts], just because that is
the central quantitative factor.”
|
No comments:
Post a Comment