Committee members argue the final rule violates the No Surprises Act and urge regulators to reconsider independent dispute resolution requirements related to the qualifying payment amount of health services.
12/06/2022 1:25 P.M.
1.5 minute read
Members of the House Committee on Ways and Means have expressed concerns that the final surprise billing rule on the independent dispute resolution (IDR) process continues to violate the No Surprises Act, according to an article from RevCycle Intelligence.
In a letter to the departments of Health and Human Services, Labor, and the Treasury, Committee Chairman Richard Neal (D-Mass.) and Ranking Member Kevin Brady (R-Texas) urged them to review the regulation.
The qualifying payment amount (QPA), which is the payer’s median contracted rate for a good or service, must be used by IDR entities for calculating reimbursement rates for out-of-network services, according to the interim final rule on surprise billing.
“The No Surprises Act states that IDR entities should consider the QPA along with other factors, such as provider training and experience, the provider’s market share, and how difficult it was to furnish the service,” according to the article.
However, stakeholders claimed that the IDR requirements do not align with what Congress detailed in the No Surprises Act and that the final rule the Biden administration released in August 2022—which aims to amend the emphasis placed on the QPA during the IDR process—violates the act.
“Although the final rule makes some limited progress by no longer designating an unlawful ‘rebuttable presumption’ towards the QPA as the interim final rule did (which a federal district court properly invalidated), we find that the new instruction to IDR entities largely would have the same effect,” the letter stated.
It continued: “Even though the No Surprises Act explicitly requires an IDR entity to separately consider all of the statutory factors, the final rule precludes IDR entities from giving weight to factors like patient acuity and the complexity of furnishing the item or service at issue unless providers meet the heightened burden of disproving double-counting within the QPA.”
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