Payers Applaud Surprise Billing Rule but Ask for Extension

With surprise billing banned by Congress in the No Surprises Act passed in December 2020, HHS has rolled out regulations that will shape the adjudication process for disputed out-of-network claims. Payers and plan sponsors are largely on board with the rules that the agency has released, but insurers have raised concerns about the pace of implementation and the long-term effect the rules will have on health care prices.

America’s Health Insurance Plans (AHIP) on Sept. 7 submitted comments on a July interim final rule (IFR) that, among other matters, outlines the way quasi-benchmark reimbursement rates, known as the qualifying payment amount (QPA), will be calculated. The insurance trade group was largely positive about the IFR, but raised concerns about the scope and timeline of payment database implementation. AHIP called on HHS to extend the implementation deadline and create a “good faith safe harbor” for plans struggling to navigate the early years of the new system’s implementation.

© 2021 MMIT

Peter Johnson

Peter has been a reporter for nearly a decade. Before joining AIS Health, Peter covered a wide variety of topics in his hometown of Seattle, where he continues to live. Peter’s work has appeared in publications including The Atlantic and The Stranger. Peter attended Colby College.

Related Posts
October 22

With COVID Testing Set to Surge, Insurers Fret About Costs

READ MORE‘Dance-Partners.jpg
October 22

Could Payers, Plan Sponsors Pick Retail ‘Dance Partners?’

READ MORE‘Virtual-First-Health-Plan-Fray.jpg
October 22

UnitedHealthcare, Cigna Join ‘Virtual-First’ Health Plan Fray

Read More


Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today