The recent No Surprises Act (NSA) ruling in the case of Tex. Med. Ass’n v. U.S. Dep’t of Health & Hum. Servs. (TMA III) has brought significant changes to the managed care industry, specifically regarding the calculation of the qualifying payment amount (QPA) and independent dispute resolution (IDR) requirements.

Speakers: Steven D. Hamilton Alexandra M. Lucas

Event Type: CLE / CPD, Webinar

Start Date/Time:
19 September 2023, 3:00 PM EDT
End Date/Time:
19 September 2023, 4:00 PM EDT

The TMA III ruling carries substantial implications for payors in the healthcare industry, necessitating a revamp of QPA calculations and compliance practices. While additional guidance from agencies is expected, it's crucial for stakeholders to adapt to these changes promptly.

During this webinar, the Managed Care team will describe the impact of the decision for payors. Additionally, we will take a deep dive into the QPA calculation changes, including those related to:

  • "Ghost Rates"
  • Specialty-Specific Rates
  • Bonus and Incentive Payments
  • Calculations by Third-Party Administrators (TPAs)
  • Single Case Agreements