CMS Updates No Surprises Act
Changes made to the law streamline the payment dispute process for providers
By Michelle Love
The Centers for Medicare & Medicaid Services (CMS) has made changes to the No Surprises Act in an effort to streamline the payment dispute process for providers—including durable medical equipment (DME) suppliers—working with group health plans and health insurers.
About the Act
The No Surprises Act (NSA) is a federal law that protects patients from receiving unexpected "surprise" medical bills by preventing out-of-network providers from billing patients for the difference between their total charges and what the patient's insurance pays.
What’s Changing
The key aspect of the new rule reduces the administrative fee per party and per dispute from $115 to $15.
CMS said the rule also allows more flexibility for claims to be resolved in a single batched dispute, which the organization hopes will reduce costs and place limits on the number of claims per batched dispute.
The agency also said the new rule "directly addresses bottlenecks by helping to reduce the number of ineligible disputes entering the system at a lower cost to payers and providers.”
According to CMS, the Independent Dispute Resolution Gateway will eventually be used to require payers to register. It hopes that this will “make it easier” for providers to identify the correct party, reduce errors and avoid unnecessary disputes. Other additional features, including in-portal negotiation, will roll out over time to improve accountability and reduce unnecessary filings.
Broad Support
In a letter sent to congressional leaders, the American Medical Association, 50 state medical societies and 46 healthcare groups announced support for the bipartisan bill.
“Our organizations remain fully committed to the core purpose of the No Surprises Act: protecting patients from surprise medical bills while ensuring physicians and other healthcare providers receive fair and timely payment for the medical services they provide,” the letter said. “We remain deeply invested in this law’s successful implementation and in achieving the balanced framework Congress intended.”
Did you Know?
MILLION
The federal Independent Dispute Resolution system has received more than 5 million disputes since its introduction in April 2022.
Michelle Love is associate editor for HomeCare Media.
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