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 IDR Portal Is Back; Prepare for New Info Requirements,” by Roy Edroso. (Read the full version – subscription required.)
Following is an excerpt:
After a long delay, the independent dispute resolution (IDR) process for providers engaged in No Surprises Act conflicts with payers came back online in December. But there are other changes - some live now, some coming soon that you’ll want to know about in case you need to use it. …
The idea is to avoid time-wasting back-and-forth late in the process by getting relevant facts straight up front, say Helaine I. Fingold of the Epstein Becker Green law firm in Baltimore.
For example, Fingold says, while current rules “require plans or issuers to send providers information on the amount of cost sharing a covered patient would owe for the out-of-network services at issue, plans or issuers are not [currently]required to disclose the nature of the patient’s coverage - that is, whether the patient is under a self-insured plan, a fully insured plan, a federal employee benefits plan [or alternative]. Moreover, even if such information is conveyed, there is no required standard for how it is to be conveyed.” The rule makes sure that’s all cleared up from the start.