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Men at business meeting The knowledge that balance billing is the only option available to the provider should they fail to negotiate with the payer, was a key incentive when it came to negotiating out-of-network (OON) balances with providers.

Editor’s note: This is the second installment of a three-part deep-dive dive into the nuances of this much-heralded piece of health care reform. Catch up on the first one here.

In direct opposition to the philosophy underpinning reference-based pricing (RBP), the No Surprises Act (NSA) does not reference any objective payment standard. In other words, there is no universally agreed-upon standard the parties can use in determining a fair payment. It should be noted that setting these payments exclusively via arbitration is a departure from initial proposals advanced by the Senate Health, Education, Labor, and Pensions Committee and the House Energy and Commerce Committee in 2019, which would have instead directly specified a “benchmark” payment rate equal to the median in-network rate for similar services. Using arbitration was a key demand of provider groups.

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