ICD10monitor December 6, 2023
To provide a No Surprises Act update, the Centers for Medicare & Medicaid Services (CMS) new Independent Dispute Resolution (IDR) guidelines face backlash from medical societies representing radiology, emergency medicine, and anesthesiology, with the groups claiming in a statement that the agency’s new guidance expands the “already significant discretion” health plans have in calculating the qualifying payment amount (QPA). One example of the current confusion is that although a recent court case (the Texas Medical Association’s third lawsuit) requires certain changes to the QPA methodology. The government is appealing the ruling, and, in the meantime, does not intend to give plans guidance on how their QPA methodology should change following the most recent litigation. The government reports that it will...
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