Before the passage of the No Surprises Act, too many patients experienced the costly burden of surprise medical bills. President Trump signed this landmark law in December 2020, and since it took effect in January 2022, it is preventing approximately 1 million surprise medical bills per month from health care facilities, providers, and air ambulances.
Unfortunately, implementation of the No Surprises Act’s arbitration process, also known as Independent Dispute Resolution (IDR), has also led to higher costs and too much red tape. The Coalition Against Surprise Medical Billing (CASMB) recently sent a letter to the incoming Trump Administration underscoring the ongoing challenges with the arbitration process and the urgency around reforms.
The latest federal data underscores how far the arbitration process has strayed from the intended outcome. Not surprisingly, some providers are misusing or abusing the IDR process to maximize reimbursements at the expense of patients, employers, and the broader health care system. More than 657,000 arbitration cases were filed in 2023 – 70 percent of which came from just four private equity-backed organizations: Team Health, SCP Health, Radiology Partners, and Envision.
Data from the Centers for Medicare & Medicaid Services (CMS) analyzed by researchers at Georgetown University’s Center on Health Insurance Reform further found that out-of-network providers are routinely submitting ineligible, incomplete, or incorrect claims to the IDR process. Additionally, an analysis by the Brookings Institution found providers are winning in arbitration 80% of the time – and that their payment was on average three times the typical in-network rate.
These trends exacerbate inflationary pressure on overall health care costs and undermine the cost-savings measures included in the law.
To protect employers, patients, and families, the Trump Administration and Congress should take constructive, common-sense steps to address current flaws with the IDR process, including:
- Mandate that IDR entities (arbiters) provide employers and health plans all the relevant information needed to process payment determinations;
- Prevent ineligible claims – including Medicare, Medicaid, state-arbitration claims, in-network claims, and claims that have already been through arbitration – from being entered into the arbitration portal and prohibit IDR entities from issuing payment determinations on these ineligible claims;
- Establish timely processes for correcting or addressing errors on non-eligible claims;
- Ensure clear and timely communications on all parties involved with IDR via a dynamic portal maintained by CMS;
- Require and enhance training and oversight for IDR entities on the No Surprises Act statute and guidance to ensure compliance and mitigate instances of abuse or misuse; and
- Mandate timely and transparent disclosures on IDR utilization by individual providers, as well as transparency on IDR entities’ performance to ensure objective decision-making.
CASMB stands ready to work with the Trump Administration to ensure the law succeeds in protecting patients from unnecessary costs and excessive regulatory burdens.
For more information on the No Surprises Act, visit stopsurprisebillingnow.com.
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