August 22, 2022
  • The Biden administration released a final rule banning surprise medical bills after suffering several legal setbacks to the No Surprises Act.Most notably, the final rule provides new details for the independent dispute resolution process, eliminating the requirement that arbitrators must give more weight to the out-of-network rate, including the qualified payment amount (QPA), over other permissible factors. The rule stipulates that certified independent dispute resolution (IDR) entities must consider the QPA and then must consider all additional permissible information submitted by each party to determine which offer best reflects the appropriate out-of-network rate. Certified IDR entities must also explain their payment determinations and underlying rationale in a written decision submitted to the parties and the departments. (Press release here; Articles here, here, here, and here)