Author: Patsy Newitt
Becker’s ASC Review
The No Surprises Act has created financial challenges for anesthesiologists, the American Society of Anesthesiologists said Nov. 15.
The implementation of the law has harmed physicians specifically at small and medium-sized practices, the society said in a news release. Insurance companies have slashed payments for anesthesiologists by nearly 40 percent in many cases.
The ASA proposed a number of changes to the implementation of the No Surprises Act in a Nov. 14 letter to CMS’ Center for Consumer Information and Insurance Oversight.
Here are three of the changes anesthesiologists are proposing:
1. Audit payer qualifying payment amounts
According to the release, there have been ongoing reports of payers using inaccurate qualifying payment amounts, including many unreasonably low rates inconsistent with local in-network contract rates. ASA proposes CMS implement audits of payer QPAs.
2. Lift resolution dispute holds
There have been numerous reports of independent dispute resolution holds on anesthesia claims, some in place for 90 days or longer, that are impacting anesthesiologist practices. The ASA recommends CMS lift these holds and develop guidance that improves the independent dispute resolution process.
3. Improve batching rules
CMS policy batches anesthesia claims by limiting them to the same service facility, CPT code and payer, preventing anesthesiologists from efficiently batching claims. New guidance should align with provider-payer contracting practices based on an anesthesia conversion factor, ASA said.