HHS Finalizes Surprise Billing Arbitration Rule Despite Payer Opposition
The Department of Health and Human Services finalized a rule Thursday updating the independent dispute resolution process for out-of-network billing disputes under the No Surprises Act. The rule revises how arbiters weigh the qualifying payment amount and other factors when resolving payment disputes between health plans and providers. Health plans criticized the final rule, arguing it does not adequately address provider overuse of arbitration or curb what they characterize as excessive out-of-network charges. The rule takes effect 60 days after publication in the Federal Register.
Medicaid managed care organizations with affiliated commercial lines or dual-eligible populations may face increased arbitration costs and administrative burden if providers escalate disputes over emergency and out-of-network claims.
Managed Care · Finance
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