The CMS’ first audit of an insurer for compliance with a law preventing surprise bills for consumers found some evidence to support provider allegations that insurers are gaming the system to lower or delay payments for out-of-network medical services. That’s in part because insurers set the initial payments to providers for out-of-network care, which are often tied to a metric called the qualifying payment amount, or QPA. The QPA is also used by third-party arbiters to decide on a final reimbursement for providers if they can’t agree with insurers on an amount.
Read the full article: CMS’ First No Surprises Audit Targets Aetna, Finds Some Noncompliance //
Source: https://www.healthcaredive.com/news/cms-no-surprises-first-audit-aetna-texas/721126