NSA Update (Winter Edition)

NSA Update 

• TMA lawsuits #1 and #2 – Decided in favor of TMA. The Judge vacated arbitration criteria language in the regulations. The Federal Government is appealing TMA 2.
• TMA #3 – The Judge vacated QPA formula language. The Federal Appeals Court partially reversed the decision.
• TMA #4 – The judge vacated the $350 IDR fee and batching language after determining the language was in violation of the Administrative Procedures Act. The Departments response to the judge’s decision were as follows :
• The IDR administrative fee was reduced from $350 to $115.
• Improved CPT batching criteria was implemented for radiology and anesthesiology, but not for emergency medicine.
• Small changes were made to issuer-related batching processes.

The new administration will set the tone regarding all regulatory and enforcement actions related to the NSA, including the much-delayed IDR operations rule. A congressional bill related to IDR payments faces an uncertain future.

BSA Healthcare Opinion

Extensive regulatory and Congressional advocacy efforts by EDPMA and ACEP need to continue. Insurers will put intense pressure on the Departments to loosen their responsibilities and place downward pressure on QPA determination. The new administration Departments will publish numerous regulations and guidance that will affect the continued implementation of the NSA. Additionally, change of congressional majorities may have a major impact on legislation impacting the NSA.