The Federal government recently proposed changes to the NSA IDR process in hopes of holding all involved organizations more accountable and forcing initiating and non-initiating parties to be more diligent in documentation and timely admin fee payments. While the end goal may be to increase speed, efficiency, tracking and transparency, the immediate result is health … Get Ready: CMS Proposes Numerous Changes to IDR Process
The Expion Health team left the Self-Insurance Institute of America, Inc. 2023 Conference energized and inspired. We had insightful conversations with over 40 different organizations and immersed ourselves in thought-provoking speaker sessions. 🔑 The key takeaway: Self-insured groups and administrators are assessing their current approach to managing medical claims costs, leading them to reevaluate their … Expion Insights from SIIA 2023
NSA currently excludes Urgent Care and Ground Ambulance services despite pressure to do so. However, some states have begun to provide protection. This means self-funded employers must determine which coverage to use. What may seem like the right path may not always make the most economic sense. To ensure the best savings, self-funded plans should … NSA Minute: Ground Ambulance & Urgent Care Services
Blue Shield’s shift from a single PBM to multiple specialized partners for pharmacy benefits management has health plans wondering if disaggregation is right for them. At Expion Health, we’re here to highlight why this shift matters and how we can support health plans like yours with this strategy. 1. Strategic Alignment: Partnering Without Conflict Moving … Blue Shield of California Pharmacy Shake-Up: 3 Disaggregation Considerations for Health Plans
There are 5 costly challenges payers still face when it comes to NSA claims. These challenges are exposing payers to compliance risks and upsetting members. Expion Health’s NSA Navigator is designed to solve those challenges. Don’t expose yourself to NSA compliance and member satisfaction risks. Understand the top challenges payers face and how to solve … Top 5 NSA Challenges & Solutions for Payers
Independent dispute resolution (IDR) has gained remarkable popularity among healthcare providers since the implementation of the No Surprises Act (NSA). The statistics from the first year of the NSA reveal an unexpectedly high volume of IDR cases—14 times more than initially projected. As of March 31, 2023, IDR entities have issued a substantial 42,158 payment … Inside the Numbers: The Surging Popularity and Impact of IDR under the No Surprises Act
The Independent Dispute Resolution (IDR) process for NSA continues to deliver surprises and complexities for payers. For example, in a February IDR ruling, a provider was required to refund money to a payer! A successful IDR outcome requires a strong strategy. It’s essential to have a skilled team that is current on IDR guidance and … NSA Minute: IDR Surprises
Legal challenges to the No Surprises Act (NSA) continue to arise with six lawsuits brought forth so far. One lawsuit challenging the constitutionality has failed, but challenges to the regulations used to enforce the statute have continued to erode timely decisions in the independent dispute resolution (IDR) process. Another is challenging the QPA methodology around … NSA Minute: Impact of Legal Challenges
At the end of 2022, half of hospitals are in the red — putting pressure on hospitals to look for new opportunities to increase revenue. This year, OIG added to the pressure with transparency in coverage enforcement and by looking at hospitals seeking to obtain bad debt recoveries from CMS. All of this is compounded … NSA Minute: Hospitals’ Financial Strategy
As we follow the impact of NSA, we continue to see unexpected scenarios occur. For example, with out-of-network at an in-network facility or even emergency care, we assume this excludes office visits. However, recently it has been shown that there are unique instances where office visits could fall under NSA around radiology and clinical lab. … NSA Minute: Unexpected Scenarios
