With surprise billing banned by Congress in the No Surprises Act passed in December 2020, HHS has rolled out regulations that will shape the adjudication process for disputed out-of-network claims. Payers and plan sponsors are largely on board with the rules that the agency has released, but insurers have raised concerns about the pace of implementation and the long-term effect the rules will have on health care prices.
America’s Health Insurance Plans (AHIP) on Sept. 7 submitted comments on a July interim final rule (IFR) that, among other matters, outlines the way quasi-benchmark reimbursement rates, known as the qualifying payment amount (QPA), will be calculated. The insurance trade group was largely positive about the IFR, but raised concerns about the scope and timeline of payment database implementation. AHIP called on HHS to extend the implementation deadline and create a “good faith safe harbor” for plans struggling to navigate the early years of the new system’s implementation.
The surprise billing ban, which comes into full effect in 2022, prohibits providers from sending a balance bill to patients. Patients who are treated by an out-of-network provider while incapacitated will pay the same cost sharing that they would have if they had been treated by an in-network provider.
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