Ep 6 - Ensuring Reasonable and Acceptable Reimbursements with the No Surprises Act

Ep 6 - Ensuring Reasonable and Acceptable Reimbursements with the No Surprises Act

The No Surprises Act was designed to protect healthcare consumers against surprise billing. For payers, it has made processes more complex, especially relating to ensuring that reasonable and acceptable reimbursements are established and benchmarked by procedure, by provider, and by geography.

On September 30, 2021, the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury along with the Office of Personnel Management released an interim final rule, which further explains requirements related to the Independent Dispute Resolution (IDR) process and Qualified Payment Amounts.

Greg Tackett, Senior Vice President of National Accounts and Strategy at Zelis, joined our Future Healthcare Today podcast to further explore these new rules and how median in network solutions can help ensure reasonable and acceptable reimbursements.

“When payers who are not used to going through arbitration today, or if they do go to arbitration, it's on a very small amount of claims, they're going to need help and support to put the best argument forward on why what they have paid the provider is fair and reasonable, because providers will probably push back on what they're paid,” said Tackett.

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Episoder(25)

Ep 25: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 2

Ep 25: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 2

On the Future Healthcare Today Podcast with Lucas Hunsicker, Kristin Gasteazoro, Senior Vice President of SmartShopper Sales and Client Performance at Zelis, and Reagan Greene, Vice President of Brand...

24 Jul 202415min

Ep 24: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 1

Ep 24: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 1

In the Future Healthcare Today Podcast, hosted by Lucas Hunsicker, featuring Kristin Gasteazoro, Senior Vice President, SmartShopper Sales and Client Performance at Zelis, and Reagan Greene, Vice Pres...

24 Jul 202421min

Ep 23: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 2

Ep 23: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 2

Despite healthcare’s critical importance, the intricate nature of insurance plans and healthcare information can often leave individuals feeling adrift. A recent Bend Financial report found that 56 pe...

21 Mai 202415min

Ep 22: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 1

Ep 22: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 1

Despite healthcare’s critical importance, the intricate nature of insurance plans and healthcare information can often leave individuals feeling adrift. A recent Bend Financial report found that 56 pe...

20 Mai 202417min

Ep 21: Care Guidance Tools Helps Deliver High-Quality Care for Members

Ep 21: Care Guidance Tools Helps Deliver High-Quality Care for Members

People often turn to family, friends, and Google to make healthcare decisions and find healthcare providers. This can lead to confusion and misinformed decisions. Healthcare partners can – and should ...

18 Des 202323min

Ep 20 - Brokers Step in to Fill Knowledge Gaps as Healthcare Becomes More Complex

Ep 20 - Brokers Step in to Fill Knowledge Gaps as Healthcare Becomes More Complex

The Affordable Care Act, far from simplifying healthcare, has introduced many more complexities, making the jobs of HR workers even more challenging as they attempt to keep pace with the fast-changing...

17 Des 202311min

Ep 19 - New Transparency in Coverage Regulations for Machine-Readable Files Affect the Market

Ep 19 - New Transparency in Coverage Regulations for Machine-Readable Files Affect the Market

The Transparency in Coverage (TiC) regulations provide further clarification for the use of Machine-Readable Files (MRFs) for the health insurance industry. These rules require that healthcare plans a...

16 Des 202315min

Ep 18 - Clarity, Control, and Guidance: The Future of Healthcare According to Zelis

Ep 18 - Clarity, Control, and Guidance: The Future of Healthcare According to Zelis

The healthcare industry has seen its fair share of disruptions in the last few years. With the advent of telehealth and a renewed interest in taking charge of their healthcare, many members have inter...

15 Des 202317min

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