Federal court strikes down No Surprises Act payment formula

A federal appeals court this week struck down the methodology used to determine how much providers should be reimbursed in disputes over out-of-network bills under the No Surprises Act (Source: “5th Circuit strikes down No Surprises billing benchmark in win for providers,” Healthcare Dive, Aug. 13).
 
The 5th Circuit ruled that the government’s methodology for calculating the qualifying payment amount (QPA) — a metric representing average in-network rates for a service in a particular geographic area — is partly unlawful.
 
The ruling is another setback for insurers as they jockey with providers to shape the arbitration process set up by the No Surprise Act, a watershed consumer protection law passed in 2020 to shield consumers from surprise medical bills. 
 
The NSA has largely been successful in that goal, preventing millions of Americans from being hit with unexpected out-of-network charges. But it came with an unintended consequence, creating a multibillion-dollar cottage industry around dispute resolution that’s enabled doctors to get paid significantly more than they normally would for providing care.