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April 21, 2023

Flaws in the No Surprises Act and How MBM Can Help

April 21, 2023

Even with the best intentions, new legislative acts rarely solve problems without creating others. And so it is with the No Surprises Act. This piece of legislation, intended to protect patients in the wake of the COVID-19 crisis, has caused a host of issues for physicians and providers, particularly anesthesiologists. The American Society of Anesthesiologists has already proposed resolutions to these flaws, but Medical Business Management can help in the meantime. Your revenue stream can’t wait for the No Surprises Act to be fixed! 

Flaws In The No Surprises Act

There is an imbalance in the No Surprises Act, particularly in implementing the process for the insurer to pay the physician. Payment disputes are more common and often resolve in favor of insurance companies. This has empowered them not to negotiate but to adopt a “take it or leave it” attitude. Qualifying Payment Amounts (QPAs) are artificially low and don’t match local in-network rates. Additionally, there is a backlog of disputed payments, with unexplained delays for holds on claims lasting 90 days or more. This all leads to physicians not being paid fairly for services rendered, which causes many small to medium providers to close their doors, ultimately causing patients to lose access to care. A few minor fixes could lead back to fair pay and sustainable community practices. 

Are you feeling the effects of the imbalances in the No Surprises Act? We can help you handle your backlog. Contact us today

The (Proposed) Solutions 

The ASA has put forward a few solutions to help ease the burden on physicians and medical providers, especially anesthesiologists. In a letter to the Center for Consumer Information and Insurance Oversight (CCIIO), the ASA outlines recommendations such as: 

Add meaningful network adequacy requirements. 

Many payers are citing the No Surprises Act to explicitly push anesthesiologists out-of-network

Conduct an audit of payer QPAs.

Many Qualifying Payment Amounts are unreasonably low and inconsistent with a range of local in-network rates. 

Lift holds on resolution disputes for anesthesia claims.

Reports suggest there are IDR entity holds on hundreds of claims with no explanation as to the reason for the delay.

Improve the timeliness of the IDR process.

No meaningful negotiations occur between the payer and the anesthesiology practice during the 30-day mandated negotiation period, needlessly delaying the resolution of payment disputes.

Improve batching rules.

Anesthesia claim batching no longer follows the conversion factor-based standard of contracting practices between payer and anesthesiologist, exacerbating the backlog of unpaid invoices.

While these are only recommendations, we hope that meaningful change through regulation of the NSA will come soon. Until then, MBM can help! 

If you notice changes in your revenue stream due to the No Surprises Act, call us today

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