Nebraska IDR Arbitration For Medical Revenue Recovery

Nebraska Surprise Billing Law (SBL)

The Nebraska Surprise Billing Law (SBL), effective October 22, 2020, is codified under Nebraska Revised Statutes 44-6849 and 44-6850. This law governs reimbursement processes and dispute resolution for out-of-network (OON) emergency services, providing a clear framework for determining fair compensation.

Key Provisions

1. Reimbursement Rates:
   • OON reimbursement is tied to either:
     • The in-network (INN) rate, or
     • 175% of Medicare rates, whichever applies.
2. Scope of Application:
   • The law applies to emergency services provided to individuals covered under health benefit plans in Nebraska by OON providers.
3. State-Specific Application:
   • The Nebraska law serves as a specified state law for determining OON rates for emergency services in applicable situations.

Federal and State Coordination

1. No All-Payer Model Agreement:
   • Nebraska does not operate under an All-Payer Model Agreement.
2. Federal Independent Dispute Resolution (IDR) Process:
   • The Federal IDR process applies to situations outside the scope of Nebraska's state law, including:
     • Nonparticipating emergency facilities or providers not covered by Nebraska Revised Statutes 44-6849 and 44-6850.
     • Services provided by nonparticipating air ambulance providers.
3. Enforcement:
   • The Nebraska Department of Insurance collaborates with federal authorities to enforce outcomes from the Federal IDR process for cases in Nebraska.

These provisions were clarified in a CMS letter to the Governor of Nebraska, dated December 27, 2021, highlighting the integrated enforcement approach and ensuring compliance for OON reimbursement mechanisms.