Helaine I. Fingold, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Baltimore office, was quoted in Part B News, in “No Surprises IDRs Stall, but New Rules More Likely to Favor Providers,” by Roy Edroso. (Read the full version – subscription required.)
Following is an excerpt:
Several federal agencies recently issued a set of final rules based on the No Surprises Act (NSA) that affects out-of-network reimbursement of providers. These rules should make it easier for providers to contest payer decisions — that is, if CMS can break the logjam in its independent dispute resolution (IDR) process, which experts caution the new rules may worsen. …
Helaine I. Fingold, member of the Epstein Becker Green firm in Baltimore, says that the IDR entity “may not assess the credibility of the QPA as an accurate reflection of the payer’s median contracted rate. Thus, while this will help providers bringing IDR challenges, the heaviest burden will still remain on the provider to show that an amount in excess of the QPA is the appropriate payment for the services at issue.”