ASA Stated that The No Surprises Act Has Created Financial Challenges for Anesthesiologists
- According to the American Society of Anesthesiologists (ASA), the No Surprises Act (NSA) is harming anesthesiologists financially.
- The ASA sent a letter to the CMSs Center for Consumer Information and Insurance Oversight (CCIIO) to address an imbalance in the implementation of the Act.
- The letter includes nine challenges faced by anesthesiologists and specific recommendations to address them.
The American Society of Anesthesiologists (ASA) stated in a letter that the flawed implementation of the No Surprises Act (NSA) had created profound challenges for community anesthesiologists’ practices.
In the statement, the ASA urged the CMSs Center for Consumer Information and Insurance Oversight (CCIIO) to address an imbalance in the implementation of the Act. According to the Society, this imbalance has emboldened health insurance companies to push anesthesiology practices out-of-network and into a dysfunctional dispute resolution system.
The ASA described nine challenges faced by anesthesiologists and provided specific recommendations to address them. Among the most urgent are the following:
1. Audit payer qualifying payment amounts (QPAs)
According to the letter, there have been ongoing reports of payers using inaccurate QPAs, many being unreasonably low and inconsistent with most local in-network contract rates. The ASA recommended the agency implement comprehensive audits of payer QPAs.
2. Lift holds on resolution disputes
The ASA has received numerous reports of independent dispute resolution (IDR) holds on anesthesia claims. In these reports, some practices reported holds of hundreds of claims and holds in place for 90 days or longer with no explanation regarding the delay. The ASA recommended CMS lift these holds. The Society also suggested developing and implementing guidance that improves the IDR process.
3. Improve batching rules
In the statement, the ASA wrote that the CMS guidance continues a highly inefficient policy regarding batching anesthesia claims. The association said that this CMS policy limits the anesthesiologists to the same service facility, CPT code, and payer. The ASA recommended the CMS align its guidance with conventional anesthesia provider-payers contracting practices based on an anesthesia conversion factor.
Other recommendations include the following:
- Improving the timeliness of the dispute resolution process.
- Expediting payment disputes.
- Directing IDR entities to give equal consideration to all factors listed in the law.
- Developing guidance for IDR entities to investigate the status of missing items before rejecting the claim.
- Mandating the use of existing Remittance Advice Remark Codes.
- Modifying requirements for submission of data to include clear designations of plan types.
- Ensuring payer compliance with payment deadline rules and guidance.
Read the full ASA letter here: American Society of Anesthesiologists Proposes Nine Recommendations to Address Flawed Implementation of No Surprises Act.