Current Insurer Calculation of Qualified Payment Amount for Out-of-Network (OON) Care May Violate No Surprises Act

In possible violation of the No Surprises Act, health insurance company calculations of Qualified Payment Amounts (QPA) for anesthesiology, emergency medicine and radiology services (and possibly other specialty services) likely include rates from primary care provider (PCP) contracts. A new study conducted by Avalere Health and commissioned by three national physician organizations examined a subpopulation of PCPs and determined that contracting practices may directly impact the QPA. This new study raises significant concerns about the accuracy of insurer calculated QPAs. ASA remains committed to eliminating the QPA as the primary factor in arbitration and implementing a more fair dispute resolution process to ensure a level playing field for providers and continued access to quality care for patients. Read the full press release.