Category: Insights

NSA Minute: Impact of Legal Challenges

Legal challenges to the No Surprises Act (NSA) continue to arise with six lawsuits brought forth so far. One lawsuit challenging the constitutionality has failed, but challenges to the regulations used to enforce the statute have continued to erode timely decisions in the independent dispute resolution (IDR) process. Another is challenging the QPA methodology around NSA Minute: Impact of Legal Challenges

NSA Minute: Hospitals’ Financial Strategy

At the end of 2022, half of hospitals are in the red — putting pressure on hospitals to look for new opportunities to increase revenue. This year, OIG added to the pressure with transparency in coverage enforcement and by looking at hospitals seeking to obtain bad debt recoveries from CMS. All of this is compounded NSA Minute: Hospitals’ Financial Strategy

NSA Minute: Unexpected Scenarios

As we follow the impact of NSA, we continue to see unexpected scenarios occur. For example, with out-of-network at an in-network facility or even emergency care, we assume this excludes office visits. However, recently it has been shown that there are unique instances where office visits could fall under NSA around radiology and clinical lab. NSA Minute: Unexpected Scenarios

NSA Minute: Eye Opening IDR Statistics

The recent No Surprises Act’s (NSA) report from HHS, Department of Labor, and Department of the Treasury presented eye-opening statistics about the impact and challenges of independent dispute resolution (IDR). Harnessing the power of our NSA claims processing technology, we are helping clients navigate these challenges by calculating defensible QPAs, identifying claims that are ineligible for IDR, NSA Minute: Eye Opening IDR Statistics

NSA Minute: Separating NSA and Post-Stabilization Codes

As our hearts and prayers go out to Damar Hamlin and his family for a speedy recovery after his on-field medical emergency, we are reminded of the complexities of emergency care, especially if ongoing care is needed. Even after the immediate crisis has passed, post-stabilization care may still be needed. The No Surprises Act has been instrumental NSA Minute: Separating NSA and Post-Stabilization Codes

Don’t Risk It: QPA Calculation

Calculating accurate QPAs is difficult and mistakes can be costly and create compliance risks. Here’s what to do.

The Impact of Humira Biosimilars: 5 Factors That Will Reduce Payer Costs

The use of biosimilar products in lieu of originator biologic products has been a hot topic of discussion since the first FDA approval of Zarxio (a biosimilar for Neupogen) in 2015. Since then over 30 new biosimilars have been FDA approved but the biosimilar market hasn’t taken off as expected. The slower than expected uptake The Impact of Humira Biosimilars: 5 Factors That Will Reduce Payer Costs

Biosimilars 101

The biologics market could see some significant changes with the current and upcoming interchangeability approvals of several biosimilar products. Let’s dive into what biosimilars are and the importance of interchangeability. What is a biosimilar?A biosimilar is a potential alternative for an existing FDA-approved biologic. They are highly similar (can have minor differences in inactive components) Biosimilars 101

Fee Negotiation: Controlling Out-of-Network Claims Costs Following the No Surprises Act

On December 27, 2020, H.R.133 — the FY2021 Omnibus Appropriations Bill — was signed into law. Embedded within the nearly 2,200-page bill was the No Surprises Act, a significant piece of bipartisan legislation designed to protect consumers against the bitter pills that come with surprise medical billing.