Healthy Outcomes: Navigating the No Surprises Act: Opportunities and challenges for provider and payer organizations

On this episode of Healthy Outcomes, our host Mark Ross interviews Baker Tilly’s Kevin Coonan, principal in our healthcare solutions practice and Michelle Reay, senior manager. Together, they discuss the No Surprises Act (NSA), which is legislation that became effective Jan. 1, 2022 that effectively bans balance billing for air ambulance, emergency situations and in cases where an out-of-network specialist is used in otherwise in-network scenarios. In summary, the NSA is intended to protect patients from unexpected medical expenses when receiving out-of-network care.    

Topics of discussion include:  

• Top opportunities that the NSA presents for both providers and payers 
• Operational and compliance challenges for payers, such as properly calculating qualified payment amounts (QPAs) 
• Operational and compliance challenges for providers, such as navigating the independent dispute resolution (IDR) process 
• Positive impacts that the legislation can have on patient and member satisfaction 
• The operational and strategic connection between the NSA and price transparency regulations  

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