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Gain More Confidence and a Stronger Position During Open Negotiations and IDR

ZOLL Data Systems | Oct 10, 2023

Since the No Surprises Act (NSA) has gone into effect, emergency medicine (EM) physicians and emergency medical service (EMS) air ambulance providers — who are often out-of-network — have had to contend with reimbursement rates based on a qualifying payment amount (QPA). Providers have argued that the QPA is often calculated at below market rates and that this trend will continue until NSA rules are adjusted.

However, upon receiving an initial denial of payment, providers can enter the open negotiation period with payers under NSA rules. If open negotiation is unsuccessful, the Federal Independent Dispute Resolution (IDR) process is initiated, costing considerable time, resources, and expense for providers. Therefore, it is advantageous for providers work with payers directly to try to reach agreement during the open negotiation period.

Providers should look for ways to strengthen their bargaining power. Arguably, the best way may be to take advantage of best-in-class healthcare data services that can support their position during negotiations. With the power to extract charge and payment information from millions of medical claims, these healthcare data services can provide detailed intelligence that will help providers form a foundation for their arguments.

In particular, an effective healthcare intelligence offering should include ways to:

  • View total payment trends dating back to January 31, 2019
  • Compare provider rates against average reimbursement rates
  • Provide independent market data on QPA calculations

To learn more about how providers can use healthcare intelligence data services, like ZOLL® Claims Clarity, to gain better insight and strengthen their negotiating power with payers, read the full article: How Emergency Medicine Providers Can Improve Their Bargaining Power During Open Negotiation and IDR

Read More About Navigating the NSA:

The No Surprises Act: Preparing Your Practice for the Coming Challenges and Opportunities

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