RegulatoryAug 13, 2026, 04:09 PM
Nutex Health: Court Vacates 'Ghost Rates' in No Surprises Act QPA
AI Summary
The Fifth Circuit Court of Appeals issued an en banc decision vacating key portions of the July 2021 interim final rule under the No Surprises Act. This ruling prohibits insurers from including 'ghost rates' and mandates the inclusion of bonus and incentive payments in the calculation of the Qualifying Payment Amount (QPA). This decision is expected to benefit healthcare providers like Nutex Health Inc. by preventing artificial suppression of reimbursement rates in the independent dispute resolution (IDR) process.
Key Highlights
- Fifth Circuit Court of Appeals vacated key portions of the July 2021 interim final rule.
- The vacated rule allowed 'ghost rates' and excluded bonus/incentive payments from QPA calculations.
- Court ruled insurers cannot include 'ghost rates' and must include bonus/incentive payments in QPA.
- The prior rule's 'ghost rates' artificially suppressed QPA, with 85% of arbitrations exceeding QPA.
- The decision impacts the No Surprises Act's independent dispute resolution (IDR) arbitration process.
- Departments are directed to allow existing QPAs until new rules are promulgated consistent with NSA.
Price Impact
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