The drug data report is a requirement of the No Surprises Act.
The No Surprises Act (NSA) requires the collection and reporting of the prescription drug data. The report is due from health plans on June 1, 2023.
Health plans are required to report this information on prescription spending in a report to be distributed to the Department of Labor, the U.S. Department of Health and Human Services (HHS), or the Treasury Department.
In related NSA news, the State of Washington has delayed its transition to the federal NSA independent dispute resolution (IDR) process for at least another six months. The Office of the Insurance Commissioner solicited comments on adopting the federal IDR process earlier this year. Meanwhile Washington state has been utilizing its own balance billing protection laws since 2020.
To shift gears a bit to what’s happening in Washington D.C., President Biden signed a bill that terminates the COVID-19 national emergency, effective immediately. This measure ends the national emergency a month earlier than the administration had planned.
The separate public health emergency (PHE) tied to COVID-19 will remain until May 11. COBRA and other timeline flexibilities for ERISA plans allowed during the emergency will end on June 10, which is 60 days after the end of the Covid-19 national emergency.
Next, HealthAffairs conducted an analysis of more than 2,000 hospital machine readable files (MRFs) and found that negotiated rates were 60 percent of chargemaster prices for the same procedure at the same hospital. Further, hospitals with stronger market power were most likely to offer cash prices below their median negotiated rates, while hospitals in areas where insurers were stronger were less likely to do so.
Finally, HHS has reduced a massive backlog of Medicare appeals, which ends a long legal battle with the hospital industry. The agency said in a legal filing that the Medicare appeals backlog has been reduced by 99.84 percent following a lawsuit filed by the American Hospital Association (AHA) and three hospitals.
The AHA is pleased with the agency’s progress because the appeals posed a widespread threat of hospital insolvencies and patient access to care, which costs the hospital industry billions of dollars in unpaid claims.
The term “stopgap” is defined as “a temporary way of dealing with a problem, and something used as an emergency measure until something better can
As we approach the holidays and look back on the past year we had and look forward to the new year and new presidential administration,
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Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
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During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
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