HAP Radiology Billing and Coding Blog

Ever since it became effective at the beginning of 2022, the No Surprises Act (NSA) has been the subject of legal challenges from the medical provider community. In particular, legal action was filed by the Texas Medical Association, et al (TMA), to challenge the Independent Dispute Resolution (IDR) methodology, which is viewed as more favorable to insurance claims payers and grossly unfair to physicians.

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Categories: radiology, No Surprises Act

We pay a lot of attention to government regulation in healthcare, especially the Medicare Physician Fee Schedule (MPFS) that influences reimbursement not only from Medicare, but also from other payers since many commercial contracts are tied to the MPFS. Although it is the object of most focus, the Centers for Medicare and Medicaid Services (CMS) is not the only agency that regulates healthcare.

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Categories: MPFS, radiology, appropriate use criteria, information blocking, No Surprises Act

The Final Rule related to the No Surprises Act (NSA), issued August 26, 2022, clarifies and modifies the Independent Dispute Resolution (IDR) process but makes no changes to the patient protections and other provider obligations of the NSA, such as notifications and cost estimates for uninsured patients. The IDR process has been the most controversial part of the NSA, especially the stipulation of the Qualifying Payment Amount (QPA) as the primary determinant of reimbursement. The rule finalizes disclosures that insurance payers must share about the QPA and it addresses the information to be considered in the determination of payment under the IDR process.

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Categories: radiology, No Surprises Act

The decision by a US District Court in a lawsuit brought by the Texas Medical Association has invalidated a portion of the No Surprises Act (NSA). While other similar suits are still pending, this ruling will immediately impact some of the methodology to be used in settling disputes that arise under the NSA.

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Categories: No Surprises Act

The federal No Surprises Act (NSA) has been in effect for a few weeks and many practices are just now beginning to make adjustments to accommodate the law. The level of pro-active involvement might be different for practices working solely in a hospital system from those with a private office or imaging center.

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Categories: radiology reimbursement, radiology, No Surprises Act, NSA