Uncategorized

Providers Continue to Dominate Fee Dispute Resolution

Health care providers won the vast majority of the fee disputes adjudicated through the No Surprises Act’s Independent Dispute Resolution process during the first half of 2025. The volume of those disputes submitted to arbitration rose nearly 40 percent over the first half of 2024, to 1.2 million cases, and the victory rate of providers also rose, from 85 percent to 88 percent.Leading the way for providers were private equity-backed parties, with three such companies accounting for 44 percent of the disputes submitted during the first half of 2025 and ten of those companies filing nearly 70 percent of all [...]

joe2026-01-28T13:02:20-05:00January 29, 2026|Uncategorized|

Controversy Over No Surprises Act Continues

Providers and payers continue to wage war over how the No Surprises Act is being implemented. The law, enacted in 2020, was intended to prevent insured consumers from receiving surprise medical bills, especially for out-of-network care. While it has achieved that objective to a considerable degree, it has left behind providers complaining they are being underpaid for their services and payers – health insurers – insisting that the process of adjudicating such disputes, through what is known as the Independent Dispute Resolution process, is forcing them to pay far too much for providers’ services. At the heart of the debate [...]

joe2025-12-17T12:57:49-05:00December 18, 2025|Uncategorized|

Federal Health Policy Update for November 20

The following is the latest health policy news from the federal government for November 14-20. Some of the language used below is taken directly from government documents. Medicare and Telehealth In guidance issued Thursday afternoon, CMS notes that on November 6 it instructed the MACs to return a subset of telehealth claims submitted on or before November 10 that at that time were no longer payable because the statutory provisions temporarily suspending various Medicare telehealth requirements expired on October 1 or were claims CMS could not identify as payable under current law. Now, practitioners may resubmit those returned claims to [...]

joe2025-11-21T11:57:00-05:00November 20, 2025|Uncategorized|

Lack of Confidence Spawns MMWR Alternative

Citing a growing lack of confidence in federal public health reporting, the New England Journal of Medicine and the Center for Infectious Disease Research and Policy are creating a private sector alternative to the Centers for Disease Control and Prevention’s long-running Morbidity and Mortality Weekly Report (MMWR). To be launched in the next month or so, the two organizations will begin publishing what they call “public health alerts” that will be available for free, and published as needed, in a new section of the NEJM Evidence. In creating the new feature, the two groups cited a growing distrust of federal [...]

joe2025-10-23T16:25:18-04:00October 27, 2025|Uncategorized|

Governors Form New Health Care Coalition

The governors of 15 states have joined forces to create a new organization. The governors – all Democrats – announced the launch of the Governors Public Health Alliance, a group they say is “…designed to protect the health of people across the U.S.” and …will serve as a nonpartisan coordinating hub for governors and their public health leaders. The Governors Public Health Alliance will support Governors and their states in coordinating and collaborating to protect the public’s health by facilitating data sharing and communication about health threat detection, emergency preparedness and response, public health guidance and policy, and deployment of [...]

joe2025-10-21T13:47:11-04:00October 22, 2025|Uncategorized|

Feds Clarify H-1B Visa Payment Requirement

The U.S. Citizenship and Immigration Services has issued guidance on new restrictions on H-1B visas issued in a presidential proclamation on September 19. The new guidance explains that for the requirement of a $100,000 payment to apply for such a visa: The Proclamation does not apply to any previously issued and currently valid H-1B visas, or any petitions submitted prior to 12:01 a.m. eastern daylight time on September 21, 2025. In addition, the Proclamation does not prevent any holder of a current H-1B visa, or any alien beneficiary following petition approval, from traveling in and out of the United States. [...]

joe2025-10-21T10:19:34-04:00October 21, 2025|Uncategorized|

Protecting Consumers AND Providers? No Surprise

As intended, the No Surprises Act is protecting consumers from unexpected medical bills. But it’s also protecting someone else: providers. In the three years since the No Surprises Act’s Independent Dispute Resolution process was implemented, providers have won about 85 percent of cases. In 2023 and 2024, that amounted to more than $2 billion in additional payments. One aspect of the No Surprises Act that has been a surprise is the frequency with which parties are resorting to it. Originally projected to settle about 17,000 disputes a year, the process has seen more than three million disputes filed during its [...]

joe2025-10-14T15:29:39-04:00October 15, 2025|Uncategorized|

Providers Dominating No Surprise Act Dispute Resolution

Health care providers are winning the vast majority of payment disputes resolved under the No Surprises Act’s Independent Dispute Resolution process. Contrary to the expectation that the number of cases the process would adjudicate would decline once payers and providers got a better sense of what kinds of cases were being disputed and their outcome, the number of cases going into the process has only grown – considerably. And so has providers’ success rates. Providers won 70 percent of the disputes during the first quarter of 2023 and that rate rose to 87 percent by the fourth quarter of that [...]

joe2025-07-29T17:20:29-04:00July 30, 2025|Uncategorized|

Hospitals Shedding OB Services

Hospitals are closing down their obstetric services at an alarming rate – especially rural hospitals. According to a recent study: In eight states, more than two-thirds of rural hospitals do not offer OB services. In 2022, the majority of rural hospitals in three states – North Dakota, Oklahoma, and West Virginia – did not offer OB services. More than 40 percent of rural hospitals ended their OB services between 2010 and 2022 in Pennsylvania, South Carolina, West Virginia, and Florida. Between 2010 and 2022, only three states – Delaware, Utah, and Vermont – saw no termination of OB programs. During [...]

joe2025-07-10T15:10:54-04:00July 14, 2025|Uncategorized|

Federal Health Policy Update for June 26

The following is the latest health policy news from the federal government for June 20-26. Some of the language used below is taken directly from government documents. Congress Senate Majority Leader Thune and House Speaker Johnson continue to press for passage of the “One, Big, Beautiful Bill” by July 4, the deadline set by President Trump. Leader Thune had hoped to bring the bill to the Senate floor early this week but continued disagreements over cuts to Medicaid have slowed progress. Earlier this week, in an attempt to assuage senators’ concerns that the bill’s Medicaid cuts would imperil rural hospitals, [...]

joe2025-06-26T16:56:14-04:00June 26, 2025|Uncategorized|