AHA urges additional changes to improve No Surprises Act independent dispute resolution process

AHA Feb. 5 voiced support for many provisions in a proposed rule to improve how the No Surprises Act independent dispute resolution process functions, but said the departments of Health and Human Services, Labor and the Treasury still need to address several issues critical to the functionality of the IDR process, including greater oversight of payers and accuracy and transparency in how they calculate the qualifying payment amount. 

“Hospitals and health systems report that payers consistently are not complying with IDR determinations, including one member who testified before Congress earlier this year that payers had made timely payment in only one-third of the disputes decided in the health system’s favor,” AHA wrote. “The health system was still owed $40 million in reimbursement for disputes that had been decided but for which the payer had not remitted payment within the required timeframe. This behavior cannot persist. The delay or loss of millions of dollars in reimbursement only harms patients by starving providers of the resources they need to deliver care. … We recognize that the departments are working on additional rulemaking related to the NSA, and we urge the departments to address these issues through that process.”