Pediatrix Medical Group Comments on No Surprises Act Final Rule

Rhea-AI Summary

Pediatrix Medical Group, Inc. (NYSE: MD) commented on the final rule from August 19, 2022, regarding the No Surprises Act. The rule stipulates that the qualifying payment amount (QPA) is one of several factors considered in the independent dispute resolution (IDR) process for out-of-network payment rates. Key factors include provider training, market share, patient acuity, facility status, and good faith negotiations. Pediatrix emphasizes the importance of safeguarding against potential payor manipulation of the QPA and is committed to ensuring compliance with the new rules for the continuity of care.

Positive

• Emphasis on critical factors in the IDR process, which may support Pediatrix's reimbursement strategies.
• Commitment to address potential payor manipulation, ensuring better financial outcomes for the company.

Negative

• No explicit prescription on QPA calculation could lead to ongoing disputes and potential financial risks.

FORT LAUDERDALE, Fla.--(BUSINESS WIRE)-- Pediatrix Medical Group, Inc. (NYSE: MD) today provided commentary on the final rule issued on August 19, 2022 by the Departments of the Treasury, Labor, and Health and Human Services related to the No Surprises Act.

The final rule states that a qualifying payment amount (QPA), described as a calculation of a median in-network rate, is only one of multiple inputs to be considered by the arbitrators in the independent dispute resolution (IDR) process by which out-of-network providers and insurers are required to arbitrate payment rates, and that the very important non-QPA factors must also be considered by the arbitrators. These factors are:

1) The level of training, experience, and quality and outcomes measurements of the provider or facility that furnished the qualified IDR item or service (such as those endorsed by the consensus-based entity authorized in section 1890 of the Social Security Act).
2) The market share held by the provider or facility or that of the plan or issuer in the geographic region in which the qualified IDR item or service was provided.
3) The acuity of the participant, beneficiary, or enrollee who received the qualified IDR item or service, or the complexity of furnishing the qualified IDR item or service to the participant, beneficiary, or enrollee.
4) The teaching status, case mix, and scope of services of the facility that furnished the qualified IDR item or service, if applicable.
5) Demonstration of good faith efforts (or lack thereof) made by the provider or facility or the plan or issuer to enter into network agreements with each other, and, if applicable, contracted rates between the provider or facility and the plan or issuer during the previous four plan years.

These factors, which were part of the bipartisan legislation, are important to Pediatrix, as the nation’s leading provider of very high-acuity and broad-based care to mothers, babies and children.

The Company also believes that the Departments should have explicitly prescribed the proper calculation of the QPA since the Departments are aware of improprieties by payors that can be used to manipulate the QPA, as evidenced by the many examples cited in the rule. Fortunately, in several parts of the rule, including the more detailed “Frequently Asked Questions,” the Departments shine a bright light on potential payor manipulation and provide language to safeguard against misuse.

Pediatrix intends to do everything necessary to make certain that payors do not violate the rules that were just released. Such violations could put at risk the very necessary continuity of care for mothers, babies and children at their most vulnerable hours, days and weeks.

Finally, Pediatrix is pleased that the Departments intend future rules, which the Company expects will provide more clarity and better protection for the doctor-patient relationship.

ABOUT PEDIATRIX MEDICAL GROUP

Pediatrix® Medical Group, Inc. (NYSE: MD) is the nation’s leading provider of physician services. Pediatrix-affiliated clinicians are committed to providing coordinated, compassionate and clinically excellent services to women, babies and children across the continuum of care, both in hospital settings and office-based practices. Specialties include obstetrics, maternal-fetal medicine and neonatology complemented by more than 20 pediatric subspecialties, as well as a newly expanded area of pediatric primary and urgent care clinics. The group’s high-quality, evidence-based care is bolstered by significant investments in research, education, quality-improvement and safety initiatives. The physician-led company was founded in 1979 as a single neonatology practice and today provides its highly specialized and often critical care services through more than 4,800 affiliated physicians and other clinicians in 37 states and Puerto Rico. To learn more about Pediatrix, visit www.pediatrix.com or follow us on Facebook, Instagram, LinkedIn, Twitter and the Pediatrix blog. Investment information can be found at www.pediatrix.com/investors.

Certain statements and information in this press release may be deemed to contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, Section 27A of the Securities Act of 1933, as amended (the “Securities Act”), and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements may include, but are not limited to, statements relating to the Company’s objectives, plans and strategies, and all statements, other than statements of historical facts, that address activities, events or developments that we intend, expect, project, believe or anticipate will or may occur in the future. These statements are often characterized by terminology such as “believe,” “hope,” “may,” “anticipate,” “should,” “intend,” “plan,” “will,” “expect,” “estimate,” “project,” “positioned,” “strategy” and similar expressions, and are based on assumptions and assessments made by the Company’s management in light of their experience and their perception of historical trends, current conditions, expected future developments and other factors they believe to be appropriate. Any forward-looking statements in this press release are made as of the date hereof, and the Company undertakes no duty to update or revise any such statements, whether as a result of new information, future events or otherwise. Forward-looking statements are not guarantees of future performance and are subject to risks and uncertainties. Important factors that could cause actual results, developments, and business decisions to differ materially from forward-looking statements are described in the Company’s most recent Annual Report on Form 10-K and its Quarterly Reports on Form 10-Q, including the sections entitled “Risk Factors”, as well the Company’s current reports on Form 8-K, filed with the Securities and Exchange Commission, and include the impact of surprise billing legislation and applicable implementing rules; the impact of the Company’s name change; the impact of the COVID-19 pandemic on the Company and its financial condition and results of operations; the effects of economic conditions on the Company’s business; the effects of the Affordable Care Act and potential changes thereto or a repeal thereof; the Company’s relationships with government-sponsored or funded healthcare programs, including Medicare and Medicaid, and with managed care organizations and commercial health insurance payors; the Company’s ability to comply with the terms of its debt financing arrangements; the Company’s transition to a third-party revenue cycle management provider; the impact of the divestiture of the Company’s anesthesiology and radiology medical groups; the impact of management transitions; the timing and contribution of future acquisitions; the effects of share repurchases; and the effects of the Company’s transformation initiatives, including its reorientation on, and growth strategy for, its pediatrics and obstetrics business.

View source version on businesswire.com: https://www.businesswire.com/news/home/20220822005637/en/

Charles Lynch

Senior Vice President, Finance and Strategy

954-384-0175, x 5692

charles.lynch@pediatrix.com

Source: Pediatrix Medical Group, Inc.

FAQ

What does the No Surprises Act final rule entail for Pediatrix (MD)?

The final rule requires that the qualifying payment amount (QPA) is only one of several factors in determining out-of-network payment rates.

How does Pediatrix Medical Group plan to address payor manipulation?

Pediatrix intends to ensure compliance with the new rules to protect against payor manipulation of the QPA.

What are the key factors in the IDR process mentioned by Pediatrix (MD)?

Key factors include provider training, market share, patient acuity, facility status, and negotiation efforts.

When was the final rule related to the No Surprises Act issued?

The final rule was issued on August 19, 2022.

What is the importance of the new rules for Pediatrix (MD)?

The new rules are crucial for ensuring continuity of care for mothers, babies, and children.