The No Surprises Act changed how out of network care gets billed and, more importantly, how disputes over that billing get resolved. For a physician who bills out of network, the practical center of the law isn't the patient protection piece everyone's heard of, it's the Independent Dispute Resolution process, the mechanism that decides what a payer actually owes when there's disagreement.
The Qualifying Payment Amount, the QPA, is the number a payer proposes as fair, and it's the starting point for every dispute, not the ending point. Understanding how a QPA is calculated, and where it tends to undervalue a specific service, is the difference between accepting an unfavorable number and having grounds to dispute it.
Written by John M. Abrahams, MD — board-certified neurosurgeon, founder of New York Brain & Spine Surgery.
Related: Mastering Out-of-Network Billing & the NSA
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