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Neurosurgery Comments on New Surprise Medical Billing Rules

Leading the way along with the American College of Surgeons, the AANS and the CNS sent comments to CMS in response to the first set of rulemaking implementing the No Surprises Act. The law bans surprise medical bills for out-of-network care and removes patients from payment disputes between health plans and providers. The comment letter urged the Departments of Health and Human Services, Labor and Treasury to:

  • Apply the “prudent layperson” definition for emergency medical services;
  • Require self-funded Employee Retirement Income Security Act plans to follow federal rather than state surprise medical billing rules;
  • Improve the methodology for calculating the qualifying payment amount (QPA) — generally the median in-network rate — for determining patient cost-sharing;
  • Compel health plans to provide physicians with information on how the QPA is calculated, among other information; and
  • Clarify that the QPA does not necessarily reflect actual commercial market payment rates.

Click here to read surgery’s comment letter.