The Enforcement Act. The No Surprises Act (NSA) arbitration process, known as the Federal IDR has a glaring deficiency. The enforcement of arbitration awards is placed in the hands of CMS, with the Federal Arbitration Act (FAA) not being available to turn an arbitration award into a judicially enforceable judgment. CMS enforcement is ineffective to say the least, and the federal courts for the most part have held that the law needs to be clarified to permit judicial enforcement. The No Surprises Act Enforcement Act, sponsored in the House by Congressman Murphy, which will triple the award amount if carriers do not pay the award in 30 days, as required by the NSA, will be meaningless without FAA availability. All medical associations need to be throwing their support behind the Enforcement Act and msy press for the addition of the clarification making available the FAA.
Carriers Penalizing In-Network Facilities for Using Out-of-Network (OON) Providers. One of the categories eligible for NSA arbitration is “inadvertent” OON services at in-network facilities. Intraoperative neuromonitoring providers, anesthesiologists, radiologists, and surgeons, among others, fall into this category. Carriers, namely Elevance (Anthem Blue Cross), will soon begin penalizing in-network hospitals and ASC’s for using OON practitioners. This is terrible for quality of care. What if the carrier’s network is inadequate? What if the carrier favors, on a price basis, a particular in-network provider, but the quality of care is not up to the facility’s standards? This is a dramatic overreach by carriers to control the care at facilities purely on the basis of the lower cost to the carrier. This is an outrageous overreach by carriers. All medical societies must put pressure on the hospitals to in turn push back against Elevance for this outrage.