Who Mediates Payment Disputes Under The No Surprises Act
Payment disputes in the healthcare industry can be complex and difficult to resolve. The No Surprises Act, which went into effect on January 1, 2022, aims to protect patients from unexpected medical bills resulting from out-of-network care. One key aspect of The No Surprises Act is the mediation process for payment disputes between Healthcare Providers and payers. In this article, we will explore who mediates payment disputes under The No Surprises Act and how the process works.
Overview of The No Surprises Act
The No Surprises Act was passed by Congress in December 2020 as part of the Consolidated Appropriations Act. The law aims to protect patients from surprise medical bills when they receive care from out-of-network providers, such as during emergencies or when they receive care at an in-network facility but are treated by an out-of-network provider.
Under The No Surprises Act, Healthcare Providers and payers are required to resolve payment disputes through a mediation process. The goal of the mediation process is to reach a fair and reasonable payment amount for out-of-network services provided to patients.
Who Can Initiate Mediation?
Either the healthcare provider or the payer can initiate the mediation process under The No Surprises Act. If the provider believes that they are not being fairly compensated for the out-of-network services they provided, they can request mediation to dispute the payment amount. Similarly, if the payer believes that the provider is requesting an unreasonable payment amount, they can also initiate mediation to resolve the dispute.
Mediators Under The No Surprises Act
The mediation process under The No Surprises Act is facilitated by an independent third-party arbiter known as a mediator. The mediator's role is to help the parties reach a resolution to their payment dispute by facilitating communication and negotiation between the provider and the payer.
Qualifications of Mediators
- Mediators must be independent and impartial.
- They must have expertise in healthcare payment and billing practices.
- They must be approved by the Secretary of Health and Human Services.
Selection of Mediators
- Providers and payers can select a mediator from a list of approved individuals provided by the Secretary of Health and Human Services.
- If the parties are unable to agree on a mediator, one will be assigned to them by the Secretary of Health and Human Services.
How Does the Mediation Process Work?
The mediation process under The No Surprises Act follows a specific set of steps to help providers and payers reach a resolution to their payment dispute. Below is an overview of how the process works:
Initiating Mediation
The party initiating the mediation process must submit a request to the Secretary of Health and Human Services. The request must include information about the disputed payment amount, the services provided, and any other relevant details.
Selection of a Mediator
Once the request for mediation is received, the parties can select a mediator from the list of approved individuals provided by the Secretary of Health and Human Services. If they are unable to agree on a mediator, one will be assigned to them by the Secretary.
Mediation Session
Once a mediator is selected, a mediation session will be scheduled. During the mediation session, the parties will have the opportunity to present their arguments and evidence supporting their position on the disputed payment amount. The mediator will facilitate communication and negotiation between the parties to help them reach a resolution.
Resolution
If the parties are able to reach a resolution during the mediation session, the agreed-upon payment amount will be binding. If the parties are unable to reach a resolution, the mediator will issue a written determination within 30 days of the mediation session. The determination will outline the recommended payment amount based on the evidence presented during the mediation session.
Benefits of Mediation Under The No Surprises Act
The mediation process under The No Surprises Act offers several benefits to providers and payers, including:
- Facilitates communication and negotiation between the parties.
- Helps to reach a fair and reasonable resolution to payment disputes.
- Provides an efficient and cost-effective alternative to litigation.
Conclusion
The mediation process under The No Surprises Act plays a crucial role in resolving payment disputes between Healthcare Providers and payers. By facilitating communication and negotiation between the parties, the mediation process helps to reach a fair and reasonable resolution to payment disputes, ultimately benefiting patients and providers alike.
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