What's next

Many industry professionals expect providers will respond using a two-track strategy:

Continuing legal and arbitration challenges, reflecting a "fight rather than switch" strategy, while
Concurrently pursuing industry consolidation, and re-negotiating increased fees for network providers to leverage the difference between in-network reimbursement rates and the QPA, adjusted for inflation

While the primary intended effect of the NSA is to reduce the number of surprise bills and the associated adverse financial consequences for consumers, the federal government projects changes in the health care market including:

Impacts on both in-network rates and network participation by providers
Increases in willingness to go out-of-network where providers believe that the IDR process provides them with higher reimbursement than they would be able to negotiate themselves
Consolidation in the insurer market which is already highly concentrated
Changes in the supply of providers and consolidation that influence prices, access to health care, and quality of care
Provider consolidation as a means to strengthen their bargaining positions and increase their market power

Value of a medical billing partner

Most plan sponsors took a "compliance only" approach in amending their plan for the NSA. The best response to the NSA is both strategic and compliance oriented.

Instant Insights /

No Surprises Act: Why benefit pros should rethink strategies

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