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The impact of surprise billing laws on hospital-based physician prices and network participation.
Health Econ Policy Law
December 2024
College of Public Health, Ohio State University, Columbus, OH, USA.
Prior to the No Surprises Act (NSA), numerous states passed laws protecting patients from surprise medical bills from out-of-network (OON) hospital-based physicians supporting elective treatment in in-network hospitals. Even in non-emergency situations, patients have little ability to choose physicians such as anaesthesiologists, pathologists or radiologists. Using a comprehensive, multi-payer claims database, we estimated the effect of these laws on hospital-based physician reimbursement, charges, network participation and potential surprise billing episodes.
View Article and Find Full Text PDFNo Surprises Act independent dispute resolution outcomes for emergency services.
Health Aff Sch
November 2024
Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA 90089, USA.
Article Synopsis
- The No Surprises Act eliminates surprise billing and sets up an independent dispute resolution (IDR) process for conflicts between health plans and providers.
- In a 2023 analysis of IDR data for emergency medicine visits, providers won 86% of disputes, with decisions averaging 2.7 times the qualifying payment amount (QPA).
- The analysis revealed that disputes were largely influenced by a few dominant health plans and providers, leading to payments that may not accurately represent the emergency service market.
Addressing Surprise Medical Bills and Out-of-Network Prices.
JAMA Intern Med
December 2024
George Washington University School of Law, Washington, DC.
The impacts of New York's balance billing regulation on ground ambulance pricing.
Health Serv Res
October 2024
Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA.
Objective: To examine the effects of New York's surprise billing regulations on price changes by emergency ground ambulance service providers.
Study Design: We exploited a natural experiment using a difference-in-differences design with randomization inference (RI) to examine the effects of New York state regulations on the prices of emergency ground ambulances, analyzing 2012-2019 commercial claims data. In March 2015, New York implemented a law protecting patients from surprise out-of-network (OON) balance bills, including ground ambulance services.
The Controversy over Price Transparency: Patients and Plastic Surgeons Disagree.
Plast Reconstr Surg Glob Open
October 2024
Institute of Dermatology and Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Background: The No Surprises Act (NSA) went into effect on January 1, 2022. This federal law is designed to minimize surprise bills for emergency care, out of network (OON) care, and care for uninsured or self-pay individuals. To achieve these goals, the NSA relies heavily on physicians providing cost estimates to patients prior to administering care.
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