Administration Takes First Step To Stop Surprise Billing, Leaves IDR For Future Rule

The Biden administration’s highly anticipated first surprise billing rule provides the definition and methodologies for calculating the qualifying payment amount (QPA), or in-network rate, that must be used for determining payment and cost-sharing, but leaves for future rulemaking the hot-button issue of what factors arbitrators can consider in independent dispute resolutions. The interim final rule issued Thursday (July 1) adopts state insurance commissioners’ broad definition of a geographical area and closely tracks the statute, according to stakeholders who praised the...