{
  "id": 699279,
  "title": "Appeals court tosses methodology for calculating NSA qualifying payment amounts",
  "url": "https://urgent.news/2026/08/12/appeals-court-tosses-methodology-for-calculating-nsa-qualifying",
  "topic": "health",
  "section": "Health & Medicine",
  "published": "2026-08-12T19:08:52.000Z",
  "source": {
    "name": "Fierce Healthcare",
    "slug": "fierce-healthcare",
    "url": "https://www.fiercehealthcare.com/regulatory/appeals-court-tosses-methodology-calculating-nsa-qualifying-payment-amounts"
  },
  "original_language": "en",
  "account": "A federal appeals court has overturned the methodology used to calculate qualifying payment amounts (QPA) for out-of-network claims under the No Surprises Act. The Fifth Circuit Court of Appeals ruled in favor of healthcare providers, rejecting the established methods for determining QPA, which is crucial in the first phase of dispute resolution. Initially, payers would use the median of their in-network rates for a service as their QPA. However, the court determined that these amounts should exclude \"ghost rates,\" which are artificially low rates set by payers for services they do not actually provide. While some providers argued that rates of $0 should be excluded, the court allowed for very low rates, such as $1, to remain in the calculations. The court also ruled that payers cannot exclude bonus or incentive payments from QPA calculations, but agreed to allow insurers to exclude one-off agreements. The case was initially brought by the Texas Medical Association, a hospital, and a physician. A federal district court had sided with the providers, leading to an appeal from the federal government. The judges emphasized that agencies cannot survive judicial review if their mistakes are so egregious that chaos would result, as the agencies had exercised enforcement discretion while their appeal was pending.",
  "summary": "A federal appeals court has tossed key methodology used to resolve out-of-network claims under the No Surprises Act.",
  "key_points": [],
  "editors_take": null,
  "illustration": null,
  "coverage": {
    "outlets": 1,
    "also_reported_by": []
  },
  "ai_generated": true,
  "disclaimer": "Summaries, key points and the editor’s take are written by software from other outlets’ reporting and may contain errors — always check the linked original."
}