For the second time in less than a month, a federal court has rejected the manner in which federal agencies are implementing the Independent Dispute Resolution process of the No Surprises Act, the 2020 law designed to protect consumers from surprise medical bills.
In its ruling the court found that the process established by federal agencies to establish the Qualifying Payment Amount, or QPA, which is the median rate insurers pay for in-network services and a critical factor in adjudicating payment disputes between providers and payers, inappropriately permits insurers to depress that rate – a result the court likened to setting “ghost rates” – and in so doing unfairly favors payers over providers in the Independent Dispute Resolution process.
That process is currently suspended by the Centers for Medicare & Medicaid Services in light of another federal court ruling earlier this month that CMS had inappropriately increased the rates parties must pay to initiate the dispute resolution process over a contested fee.
Learn more about this latest blow to the troubled implementation of the No Surprises Act from the Healthcare Dive article “Texas judge rules to vacate more No Surprises Act regulations” and from the federal court decision itself.