Summary of article from Healthcare Dive, by Rebecca Pifer:
The CMS’ first audit under the No Surprises Act found Aetna in Texas noncompliant with several key requirements, particularly in its calculation of qualifying payment amounts (QPAs) for air ambulance services. Aetna used incorrect methodologies, leading to both overestimations and underestimations of QPAs, and failed to provide necessary disclosures to providers. This lack of compliance could hinder the arbitration process, already burdened with backlogs. Aetna has since corrected its practices and must self-audit QPA calculations from 2022 onwards. The audit highlights ongoing disputes over QPA methodologies, which have led to legal challenges and delays in the arbitration process.