The flawed implementation of the No Surprises Act has created profound financial challenges for community anesthesiologists’ practices that can be resolved through solutions proposed by the American Society of Anesthesiologists (ASA).
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.
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.