New data from the Center for Medicare & Medicaid Services (CMS) on implementation of the No Surprises Act (NSA) found that some providers are still attempting to balance bill patients and continue to submit ineligible, incomplete, or incorrect claims to the independent dispute resolution (IDR) process, also known as arbitration.
Researchers from Georgetown University’s Center on Health Insurance Reform highlight that the No Surprises Act is fulfilling its mission to protect patients from these now banned charges. However, the data is clear that the ongoing implementation challenges with the law mean that employers, employees, and consumers are bearing the high cost of providers’ continued abuse.
Read the full blog post here and highlights below:
- “While consumers are already seeing savings, process and legal challenges have hampered smooth implementation of IDR procedures, stalling the law’s objective of protecting consumers in a way that contains costs.”
- “Compared to the total numbers of claims for NSA-eligible out-of-network services, relatively few complaints have been filed. In the first 34 months since implementation, CMS reported only an estimated 14,576 complaints specifically related to NSA compliance. For comparison, two trade groups representing insurers estimate that one million claims are submitted each month for care protected by the NSA. This low complaint volume could indicate that the NSA is protecting patients from the vast majority of balance bills.”
- “Similar to previous trends, most complaints concern provider behavior….82 percent of NSA compliance complaints were filed against providers, facilities, and air ambulance entities. About 40 percent of these provider-based complaints arise from surprise billing for a non-emergency out-of-network service at an in-network facility.”
- “We interpret these complaints as allegations that providers sent balance bills prohibited by the NSA. Another 25 percent of the provider-based complaints are similar complaints with regard to emergency services. Notably, of the total closed complaints (against either providers or plans) where a determination was made about whether a violation occurred, violations were identified for about one in five complaints.”
- “Another takeaway from the November 2024 complaint data report is that far fewer complaints were filed against payors.”
- “The NSA is a landmark law that holds substantial promise for driving down costs and protecting consumers. While the CMS reports on complaint data support the general notion that the NSA is preventing unfair balance billing, the significant amount of IDR activity and the ongoing litigation should not distract from the law’s original cost containment goals.”
- “The release of more data, including ongoing complaint data, more audits, and granular data related to IDR outcomes, would help policymakers assess the impact of the NSA and whether further action to protect consumers and reduce system costs will be needed.”
For more information on the No Surprises Act, visit stopsurprisebillingnow.com.
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