Current Insurer Calculation of Qualified Payment Amount for Out-of-Network (OON) Care May Violate No Surprises Act

In possible violation of the No Surprises Act, health insurance company calculations of Qualified Payment Amounts (QPA) for anesthesiology, emergency medicine and radiology services (and possibly other specialty services) likely include rates from primary care provider (PCP) contracts. A new study conducted by Avalere Health and commissioned by three national physician organizations examined a subpopulation of PCPs and determined that contracting practices may directly impact the QPA.

Legislation for Surprise Billing May Decrease In-Network Reimbursement

A new Harvey L. Neiman Health Policy Institute study, published in Radiology, reviewed the implications of unexpected out-of-network balance billing—commonly called surprise billing—on reimbursement for hospital-based specialties such as radiology. The analysis concluded that even physicians who never engaged in such billing practices may still be impacted by the No Surprises Act, which is due to take effect in 2022.