Federal Arbiters Finalize Dispute Resolution Rule for Surprise Medical Bills
Federal regulators released a final rule Thursday governing how health plans and providers resolve payment disputes over out-of-network emergency and certain non-emergency services under the No Surprises Act. The rule refines the independent dispute resolution process that applies when plans and providers cannot agree on payment rates for surprise bills. Health plans criticized the rule for not doing enough to prevent providers from exploiting the arbitration system, while the rule's proponents say it balances provider and plan interests. The changes take effect upon publication in the Federal Register.
Medicaid managed care organizations contracting with commercial providers or operating dual-eligible plans need to understand how federal surprise billing arbitration rules affect their network adequacy strategies, rate negotiations, and member cost-sharing obligations when out-of-network care occurs.
Managed Care · Finance
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