01/27/2026
The No Surprises Act (NSA) isn't just a compliance hurdle; it’s a strategic battleground for revenue integrity. To lead your practice effectively, you need to see the traps before they snap.
Expert-to-Expert 5-Step Action Plan:
1️⃣ Audit QPA (Qualifying Payment Amount): Median in-network rates payers use. Audit now before the Feb 1 deadline.
2️⃣ Don’t Miss ONP (Open Negotiation Period): 30-day window to start negotiation. Miss it, and lose federal IDR (Independent Dispute Resolution) rights entirely.
3️⃣ Master ‘4-Modifier’ Signal: Precisely define 25-item batching (e.g., -26 professional vs. -TC technical).
4️⃣ RCA (Root Cause Analysis): Weekly "Denied Claim Huddles" to fix why claims trigger the NSA.
5️⃣ Metrics: Monitor "IDR Win Ratio" & "Cost-to-Collect." High wins are hollow if labor costs are too high.
🚨 Pivot Signals: Leadership Indicators:
📍 QPA Drift: If QPAs drop >5% vs inflation. Pivot: Audit methodology.
📍 Eligibility Ghost: >10% of IDR cases rejected as "Ineligible." Pivot: Standardize Attestation forms.
📍 Yield Gap: Cost-to-Collect >20% of claim. Pivot: Overhaul batching.
HealthPath Solutions optimizes your RCM so you focus on care.
How is your team tracking the ONP window?
https://healthpathsolutions.us