UNDERSTANDINGESTIMATESIN PRICETRANSPARENCY &NO SURPRISES

The NSA Co-Provider Portal is accessed by Users who work in conjunction with the convening provider to issue a comprehensive GFEof all reasonably anticipated charges from all anticipated providers during the scheduled service. The Co-Provider Portal can also be used to issue a GFE directly to an uninsured individual when the co-provider is scheduling the service in their office/clinic and is now considered a convening provider who must furnish all the required GFE data elements

A demonstration of how these two platforms work together to create a GFEcan be viewed at this link: CorroHealth NSA Platform Overview Demonstration (vimeo.com)

NO SURPRISESACTIDRDISPUTEFEEINCREASED BY 700% IN 2023

The administrative fee for the Independent Dispute Resolution (IDR) process has increased by 700%in 2023 The administrative fee to participate in a dispute related to the No Surprises Act (NSA) ban on balance billing jumped from $50 to $350. Given the significant increase in the fee, many providers may find that disputes are not worth the burden and forgo the process. With the volume of disputes filed in a five-month window exceeding the anticipated yearly volume, one can speculate that CMSis using the fee to alleviate some of the backlog.

In addition to the administrative fee hike, the threshold for the IDRarbitrators?fixed fee was increased to $700 in 2023, an increase of $200 over the 2022 rates. For batched cases, the maximum allowed fee increased from $670 in 2022 to $938 in 2023

Last year was the first year balance billing was banned under the NSA with respect to the following services:

- Emergency services

- Non-emergency items or services furnished by out-of-network (OON) providers at certain in-network health care facilities, and

- Air ambulance services furnished by OON providers of air ambulance services

The OON facilities and providers found themselves disputing reimbursement with health plans rather than balance billing patients The law created a process for providers and insurers to resolve payment disputes by entering into a baseball-style arbitration. When they couldn? t negotiate between themselves, they turned to certified IDRentities to resolve the dispute

The first report published by HHS, DOL, and the Treasury Department reported that over 90,000 disputes were submitted to the federal IDRportal between April 15 and September 30. The report provides some interesting data indicating how the system was overloaded Over 80%of the disputes originated from emergency department visits Only ten provider groups accounted for 75%of the disputes. United Healthcare was involved in 25%of the disputes followed by Aetna with 14% The complete report can be found at this link:

Initial Report on the Independent Dispute Resolution (IDR) Process (cms gov)