S1 Ep161: The No Surprises Act's new payment dispute rule, with Anders Gilberg of MGMA
About this episode
The episode discusses the new payment dispute rule under the No Surprises Act and its implications for physicians and practices.
When a patient is treated by an out-of-network physician at an in-network hospital, the resulting payment dispute is supposed to be settled through the No Surprises Act's independent dispute resolution process. A newly finalized rule is meant to make that process work better, and for practices, the headline change is significant: the fee to initiate a dispute has dropped from $115 to just $15. In this episode, Physicians Practice Managing Editor Keith Reynolds sits down with Anders Gilberg, senior vice president of government affairs at MGMA, to unpack what the rule actually changes, where administrative burden still weighs on practices and why so many physicians win in arbitration only to never see payment from insurers. Gilberg also responds to the insurance industry's criticism of the process, explains which specialties are most affected and lays out the regulatory developments practices should be watching through the rest of the year, from two pending HIPAA rules to the physician fee schedule. Music Credits: Moonlit Whispers by Cephas - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.com Editor's note: Episode timestamps and transcript produced using AI tools…
Topics covered
- No Surprises Act
- payment dispute
- healthcare regulation
- insurance arbitration
- physician practices
Sponsors
Copic medical liability insurance
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- S1 Ep167: What your practice is actually worth, with Andy Colbert of Ziegler
- S1 Ep166: Considering concierge? Know the legal traps first, with Ericka Adler, J.D.
- S1 Ep165: The four forces reshaping physician pay, with Tynan Kugler of PYA
- S1 Ep164: Pay is up, productivity is down. Is it sustainable? With Andy Swanson of MGMA
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