No Surprises Act independent dispute resolution outcomes for emergency services.

Health affairs scholar Pub Date : 2024-10-17 eCollection Date: 2024-11-01 DOI:10.1093/haschl/qxae132
Erin L Duffy, Christopher Garmon, Loren Adler, Adam Biener, Erin Trish
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Abstract

The No Surprises Act banned surprise billing and established a final-offer arbitration system, independent dispute resolution (IDR), to resolve disagreements between health plans and providers. One factor that arbiters must consider in the IDR process is the qualifying payment amount (QPA), the median contracted rate for the same or similar service in the same market as computed by health plans. We analyzed public IDR data from 2023 for the most common disputed professional service: evaluation and management of a moderate to severe emergency medicine visit. Providers won 86% of cases, with mean decisions 2.7 times the QPA. Private equity-backed providers won more often and higher monetary awards than other providers. The mean QPA was 2.4 times Medicare payments. Disputes were dominated by a small group of health plans and providers, so payments may not reflect the overall market for emergency services.

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无意外法》为紧急服务提供独立的争议解决结果。
无意外法案》禁止突击收费,并建立了最终报价仲裁制度--独立争议解决 (IDR),以解决医疗计划与医疗服务提供者之间的分歧。仲裁员在 IDR 程序中必须考虑的一个因素是合格支付金额 (QPA),即医疗计划计算的同一市场中相同或类似服务的合同费率中值。我们分析了 2023 年最常见争议专业服务的公开 IDR 数据:中度至重度急诊就诊的评估和管理。医疗机构在 86% 的案件中胜诉,平均裁决是 QPA 的 2.7 倍。与其他医疗服务提供者相比,私募股权支持的医疗服务提供者胜诉率更高,获得的赔偿金额也更高。平均 QPA 是医疗保险付款的 2.4 倍。纠纷主要由一小部分医疗计划和医疗服务提供者引起,因此支付金额可能无法反映急诊服务的整体市场情况。
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The opioid industry's use of scientific evidence to advance claims about prescription opioid safety and effectiveness. Medigap-guaranteed issue associated with Medicare Advantage disenrollment for beneficiaries administered a part B drug. Learning from employer experiences with paid leave policy expansions during the COVID-19 pandemic. No Surprises Act independent dispute resolution outcomes for emergency services. Correction to: The state of health information organizations and plans to participate in the federal exchange framework.
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