AAOS Challenges CMS Over No Surprises Act Implementation
By Admin | January 01, 2022
The rule takes effect January 1, 2022.
AAOS’ letter, which was signed by AAOS President Daniel Guy, M.D. on behalf of “over 34,000 orthopaedic surgeons and residents represented by the American Association of Orthopaedic Surgeons (AAOS), and the orthopaedic specialty and state orthopaedic societies that agreed to sign on.” was sent to the Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure.
The letter, which offered support for patient protection, took strong exception to CMS’ implementation of the rule. “The AAOS is alarmed by the deviation from congressional intent as evidenced in the language of the Requirements Related to Surprise Billing Part II IFC [Interim Final Rule],”wrote Guy.
Specifically, Dr. Guy, while discussing the independent dispute resolution (IDR) process, emphasized that under the No Surprises Act, the arbiter must weigh several factors equally. CMS, however, grants commercial insurers a system that “will in practice tip the scale of disputes in their favor by making the insurer-formulated Qualifying Payment Amount (QPA)—calculated as the median in-network rate—the primary factor for consideration in IDR and the presumptive appropriate payment amount,” wrote Dr. Guy.
The letter also pointed out that most providers are out-of-network not because of their “unwillingness to negotiate for in-network contracts with insurers.” Instead, they are out-of-network because...(More)
For more info please read, AAOS Challenges CMS Over No Surprises Act Implementation, by Orthopedics This Week