Webinar:  Qualifying Payment Amount

Date:  Wednesday, January 26, 2021

Time:  1:00 – 2:00 pm EST

If you miss the live event, the webinar will be recorded and available to you on-demand, whenever you have time to listen. 

Cost:  Free Webinar for SPBA members

Speakers:  Anne Tyler Hall, Tim Kennedy, Hall Benefits Law

Registration Link: https://spba.peachnewmedia.com/store/seminar/seminar.php?seminar=177241

With the passage of the Consolidated Appropriations Act, 2021 (the “CAA”), Congress ushered in the “No Surprises Act” with prohibitions on balance billing and an accompanying independent dispute resolution process. Under the “No Surprises Act,” patients are protected from surprise medical bills by being limited to in-network cost-sharing (i.e., deductibles, coinsurance, and copays) for “emergency” and other ancillary services at in-network facilities. In the absence of a contracted amount, patient cost-sharing is based upon a “Recognized Amount.” If state law is not applied, the “Recognized Amount” is the lesser of the billed charge or the Qualified Payment Amount (QPA).

During this webinar, we will discuss the following:

• How to calculate/determine the QPA for a plan year?
• How the exceptions to the general rule impact the QPA calculation (for 2022 only)
• An overview of the state law methodology for determining the reimbursement rate for the out-of-network item or service
• An overview of how the median contracted rate is calculated
• A description/definition of emergency and ancillary services to which the “No Surprises Act” applies
• How prior authorization, coverage limits, and member employee cost-sharing is treated for services subject to the No Surprises Act?
• Implications and interaction of the prohibition on surprise billing in the CAA with state surprise billing laws
• Notice and consent requirements for balance billing of non-emergency services performed at an in-network facility by an out-of-network provider
• Which plans are excluded from the “No Surprises Act” requirements?
• How the “No Surprises Act” implicates third party administrators and whether TPA service agreements should contemplate compliance with the prohibition on balance billing for emergency and ancillary services?

Webinar Technical Notes

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Anyone using Internet Explorer will not be able to listen to the audio of the live webcast through computer audio.  You will need to be using a different browser or dial in using the phone number under Announcements on the webinar screen.  

Technical Difficulties – Please call 1-866-702-3278 or use the “Chat/Help” button that appears on the left side of the webinar screen.