AMA releases ‘No Surprises Act’ IFR summary

The American Medical Association (AMA) has released a summary of the interim final rule (IFR) of the ‘No Surprises Act,’ which will go into effect in January.

AMA explains, “The IFR implements the Independent Dispute Resolution (IDR) process that can be used to settle out-of-network payment disputes between payers and physicians and other health care providers in surprise billing situations.”

AMA says that, “[The IFR] significantly undermines the fairness and independence of the IDR process by requiring IDR entities to make their decisions based on the ‘qualifying payment amount (QPA)’ unless the provider can prove otherwise. Although the QPA is meant to represent the median in-network rate, the method used to calculate it as outlined in the first IFR, will often result in lower amounts.”

AMA believes that physicians will consequently “face an uphill battle to [receive] fair payment for their out-of-network services in situations where patients have not had an opportunity to consent, such as emergency care. But perhaps even more concerning is the impact these rules will have on the ability of physicians to enter into meaningful contract negotiations with health plans who have little incentive now to offer fair contracted rates.”

AMA is “exploring all of [its] options to prevent or minimize the impact of this IFR on physicians and patients.”

AMA ‘No Surprises Act’ Interim Final Rule’ summary