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.”

Jump to Page

Privacy Preference Center

When you visit any website, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalized web experience. Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.

Strictly Necessary Cookies

These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms. You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.

Performance Cookies

These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.