The AACU submitted comments in response to an interim final rule issued by CMS that implements certain provisions of the No Surprises Act, passed as part of the Consolidated Appropriations Act of 2021. The rule aims to reduce the unexpected medical bills patients face when they receive care from an out-of-network provider often as a result of a medical emergency.
This first rule implementing the law addresses patient cost sharing for emergency services, air ambulance services provided by out-of-network providers, and non-emergency services provided by out-of-network providers at in-network facilities in certain circumstances, among other things.
The AACU expressed its support for protecting patients from gaps in their health care coverage that may result in unanticipated medical bills. The Association, however, took issue with the methodology CMS proposes for calculating the “qualifying payment amount (QPA)”, which is used to determine patient cost-sharing in surprise billing situations.
As currently constructed, the QPA does not accurately represent true median contracted rates and therefore should not play a significant role in the Independent Dispute Resolution (IDR) process that will be used to resolve surprise billing disputes between providers and payers. The AACU urged CMS to consider additional factors that should be considered in the IDR process, which will be taken up in future rulemaking.
Finally, the letter recommends improvements to notice and consent requirements to ensure that patients get the information they need to make informed decisions without placing unnecessary administrative burden on physician practices.
Read The Full Letter