Health care providers are winning more than three-quarters of all payment disputes being brought through an unexpectedly active federal Independent Dispute Resolution process.
The process, created under the 2020 No Surprises Act to settle payment disagreements between providers and payers and to spare consumers surprise medical bills – especially for receiving emergency care from providers outside of their insurer’s network. 2023 saw 13 times more disputes during the first half of 2023 – nearly 300,000 cases in all – than federal officials anticipated.
With more than 20 percent of the disputes submitted for resolution rejected as ineligible for the process, providers won 77 percent of the cases and insurers 23 percent. Typically, the winning payment amount was close to the “qualifying payment amount” – an amount that is a central part of the dispute resolution process, created by the 2020 law and defined as the insurer’s median contracted rate.
Just ten parties accounted for well over half of all cases submitted for arbitration; most of them are practice management and revenue cycle management companies.
Learn more about how the Independent Dispute Resolution process fared in 2023 from the Fierce Healthcare article “Surprise billing disputes continue to far outpace federal estimates: CMS” and find the underlying data for 2023 here on the Centers for Medicare & Medicaid Services’ “Independent Dispute Resolutions Reports” web page (available as downloadable files under “2023 Reporting Year”).