ISASS Seeks Fair Payment Dispute Resolution for Surprise Medical Billing Disputes

On November 18, 2021, ISASS and several medical societies signed 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 a rebuttable presumptive reasonable payment for out-of-network physicians engaging in the IDR process.

In the ISASS-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 qualifying payment amount 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.

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

To read the letter see attached: letter