Author Archive for Jeremy Uniszkiewicz

ACEP and EDPMA Applaud Legal Ruling to Invalidate Qualified Payment Amount Formula

ACEP and EDPMA Applaud Legal Ruling to Invalidate Qualified Payment Amount Formula

The American College of Emergency Physicians (ACEP) and the Emergency Department Practice Management Association (EDPMA) applaud the decision released yesterday by the Eastern District Court of Texas (TMA) in the “TMA III” lawsuit regarding the Qualifying Payment Amounts (QPAs) under the No Surprises Act (NSA).

ACEP and EDPMA continue to support the overall intent of the law, which was to protect patients from unexpected financial cost-sharing responsibility for out-of-network care. We are supportive of the court’s recommendation to have the law implemented in a manner consistent with its original language and intent.

To read the full statement, click here.

EDPMA Applauds the Ways and Means Committee Leadership for Urging Swift Action to Fix the Flawed Implementation of the No Surprises Act

In a strongly worded letter, Representatives Richard Neal and Kevin Brady, the Chairman and Ranking Member of the House Ways and Means Committee, urged three cabinet secretaries to take “swift action” to fix the No Surprises Act (NSA) final rule. Read the letter here.

The letter reminded the Secretaries that the No Surprises Act intentionally detailed a dispute resolution process that required arbitrators to equally consider several factors for their decision-making process, not just the Qualifying Payment Amount as some of our members are seeing in practice.

The final rule introduced a new “double counting” test that has no basis in the statutory text, directing IDR entities to “consider whether the additional information is already accounted for in the QPA… Even though the No Surprises Act explicitly requires an IDR entity to separately consider all of the statutory factors, the final rule precludes IDR entities from giving weight to factors like patient acuity and the complexity of furnishing the item or service at issue unless providers meet the heightened burden of disproving double-counting within the QPA.”

They further called out the Departments about their slow rollout of the Advanced Explanation of Benefits provision in the NSA.

EDPMA applauds the Ways and Means Committee leadership and stands with Representatives Neal and Brady in their demand to ensure the No Surprises Act aligns with the law and to “make the law’s transparency provisions a reality for patients.”