Inaccurate provider directories, also called "ghost networks," are the subject of two recent lawsuits against health insurers.
Last year, ProPublica reported on the death of Ravi Coutinho after he was unable to find adequate mental health and addiction treatment in Phoenix that was covered by the health insurance plan he purchased...
The independent dispute resolution (IDR) process is a voluntary forum for healthcare providers and health insurance issuers to resolve disputes about how much should be paid for out-of-network care. A GAO report found six of the top 10 initiating parties submitting emergency and non-emergency disputes were owned, at least in part, by...
Last week, the Biden administration announced a proposed rule through the U.S. Department of Health and Human Services (HHS), Labor and the Treasury Department that would implement the independent dispute resolution process (IDR process) outlined by the No Surprises Act, which seeks to protect patients and medical services consumers from...National News
The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) have paused the independent dispute resolution process for payment disputes between providers and insurers following a federal court decision invalidating part of the law.
The U.S. District Court for the Eastern District of...CMS Rules
On Monday, Judge Jeremy Kernodle of the U.S. District Court for the Eastern District of Texas handed down a decision that would remove major portions of the final rule for the No Surprises Act.
In 2021, the Texas Medical Association (TMA) filed suit against an interim final rule that would instruct independent arbiters to rely on the...National News
On Tuesday, the Medical Group Management Association (MGMA) released its annual regulatory burden report, which analyzes the regulatory burden placed upon providers. This year, the report highlights the issues with prior authorization, the Medicare Quality Payment Program and the No Surprises Act.
The report breaks down the responses...
The Texas Medical Association (TMA) will now lead the charge against the federal government's rules for implementing the No Surprises Act, which aims to curb surprise bills levied on patients who unknowingly or in times of emergency receive care from providers who are out-of-network for their insurance coverage.
Last week, the...
Last Friday, the U.S. Departments of Health and Human Services, Labor and Treasury issued a joint final rule that rectifies issues with the implementation of the No Surprises Act, a law that aims to curb surprise billing practices.
The rule defines the processes for payers and providers to settle payment for services provided that...
The No Surprises Act has been a hot-button point of contention among insurers and providers as physician groups feel threatened by the leverage that insurers are given through the Act's enforcement. The Medical Group Management Association (MGMA) sent a letter to the U.S. Department of Health and Human Services (HHS) and the Centers for...National News
American Health Insurance Plans (AHIP) teamed up with the Blue Cross Blue Shield Association (BCBSA) to provide the data on commercially insured patients in the first two months of 2022.
Most of the No Surprises Act's provisions took effect at the beginning of 2022, applying to those enrolled in health insurance coverage or a group...CMS Rules
The No Surprises Act, a law that aims to protect Americans covered by private health plans from receiving surprise medical bills relating to emergency services or non-emergency services from out-of-network providers at in-network facilities, has been met with trouble since its implementation at the beginning of the year.
In February,...National News
A federal judge for the eastern district of Texas struck down a controversial aspect of the No Surprises Act last week, leaving in place protections for patients but siding with providers that a qualifying payment amount is not the appropriate out-of-network rate.
The No Surprises act formally went into effect on January 1 of this...National News
The No Surprises Act, which intends to end the practice of surprise billing by banning most surprise bills from out-of-network providers went into effect on January 1. The rule will effect not only all emergency care billing and "most" nonemergency billing but will also require uninsured patients receive overviews of anticipated costs...National News
The American Hospital Association (AHA) and American Medical Association (AMA) have sued the federal government over the implementation of the federal surprise billing law – specifically, a provision of a rule set to take effect January 1, 2022.
Both associations assert the provision ignores the No Surprises Act and would result...National News
On Thursday, an interim final rule was passed laying out the new independent dispute resolution (IDR) process for the surprise billing law. The No Surprises Act, passed in December 2020, bans surprise billing for out-of-network emergency and non-emergency services, limits cost-sharing to in-network rates, and creates the new IDR process....
