The No Surprises Act: What You Need to Know


This half-hour webinar provides instruction on several issues arising under the Consolidated Appropriations Act of 2021, which was primarily enacted to provide COVID-19 pandemic relief but also contains the No Surprises Act (the “Act”). Under the Act, providers are prohibited from balance billing members for emergency services, services provided by in-network facilities at out of network facilities and out of network air ambulance bills. Instead, providers are only entitled to the Qualifying Payment Amount (QPA) for those services. In the event the QPA is disputed by the plan and the provider, Independent Dispute Resolution (IDR) is required.


Topics:

• Determination of the QPA

• Median Contracted Rate Determination

• Geographical QPA Considerations

• Information Dispute Negotiation

• IDR Process

• QPA Presumption