Resolving Surprise Medical Bill Disputes

IPSIS signed onto a letter urging the U.S. Department of Health and Human Services to revise requirements set forth in the most recent Interim Final Rule implementing the No Surprises Act. The act directs Independent Dispute Resolution (IDR) entities to consider the qualifying payment amount (QPA) a rebuttable presumptive reasonable payment for out-of-network physicians engaging in the IDR process.

In the IPSIS-supported letter, medical societies ask that the rule conform with the act’s statutory language to allow IDR entities the discretion to consider relevant information submitted to determine a fair out-of-network payment to physicians. There is concern that the requirements in the rule establishing the QPA as a rebuttable out-of-network rate will make it more difficult for physicians to receive fair payment for out-of-network services and enter into meaningful contract negotiations with health plans which now have little incentive to offer fair contracted rates.

IPSIS anticipates the release of the final rule in early 2022.

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