No Surprises Act

Developments in No Surprises Act/Independent Dispute Resolutions

Recent weeks have seen several developments and new information in the use of the No Surprises Act’s independent dispute resolution process for health care billing disputes between payers and providers over out-of-network care. The number of disputes directed to independent dispute resolution continues to rise – 16 percent more during the second half of 2025 than during the first half of that year. Providers continue to initiate about three-quarters of the disputes and to win about 85 percent of those cases. Most of the provider-driven disputes are intiated by small provider groups, many of them represented by just a few [...]

joe2026-07-23T15:42:59-04:00July 27, 2026|Uncategorized|

Federal Health Policy Update for July 23

Don’t Miss: Congress advances health care bills CMS proposes provider tax rule Courts act on ACA changes, 340B The following is the latest health policy news from the federal government for July 17-23. Some of the language used below is taken directly from government documents. Congress The House Energy and Commerce Committee held a markup for 29 bills, advancing the following health care transparency measures with bipartisan support: H.R. 9390, Prices on the Wall Act of 2026 H.R. 9393, Lower Costs, More Transparency Act of 2026, part of a package that also includes: H.R. 3514, Improving Seniors’ Timely Access [...]

joe2026-07-23T16:29:15-04:00July 23, 2026|340b, Affordable Care Act, MACPAC, Medicaid managed care, Medicaid regulations, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for July 16

Don’t Miss: CMS proposed 2027 physician payment regulation House Ways and Means passes health care bills DHS publishes new, final public charge rule HHS pursues delivery models for potential psychedelic drugs for behavioral health treatment The following is the latest health policy news from the federal government for July 10-16. Some of the language used below is taken directly from government documents. CMS – Proposed 2027 Medicare Physician Fee Schedule Rule CMS has published its proposed physician fee schedule rule for 2027. Highlights include: A proposed reduction in Medicare physician rates. A reduction of payments for evaluation and management (E/M) [...]

joe2026-07-16T16:13:25-04:00July 16, 2026|340b, Accountable Care Organization, ACO, Alternative payment models, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for June 18

Don’t Miss: 340B Rebate Model pilot program – next steps Stricter rules on CMS’s reviews of new and existing section 1115 Medicaid demonstration programs Changes in health care institution accrediting practices HHS posts mental and behavioral health grant opportunities The following is the latest health policy news from the federal government for June 12-18. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will return to session on June 22. The House Energy and Commerce Committee’s Oversight and Investigations Subcommittee will hold a hearing titled “State Medicaid Program Integrity: Examining Fraud Risks [...]

joe2026-06-18T16:07:51-04:00June 18, 2026|340b, Affordable Care Act, Alternative payment models, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for May 28

The following is the latest health policy news from the federal government for May 22-28. Some of the language used below is taken directly from government documents. Congress When Congress returns from the Memorial Day recess next week, lawmakers will have to address the Republican-led reconciliation bill to fund ICE and CBP. After, they plan to start working on a third party-line bill focusing on affordability—including health care—which leadership aims to pass by the end of July. Next week, the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies is scheduled to mark up its Fiscal [...]

sysadmin2026-05-28T17:43:32-04:00May 28, 2026|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, MACPAC, Medicare, Medicare regulations, Medicare reimbursement policy|

No Surprises Act Activity in 2025

A new Health Affairs report offers a preliminary look at No Surprises Act Independent Dispute Resolution activity for 2025. Among its findings: Providers and facilities initiated 99.9 percent of the disagreements submitted to the IDR process. Four provider groups or representatives of provider groups initiated more than half of those cases. Providers prevailed in 88 percent of the cases. Health plans challenged 40 percent of the cases submitted to the IDR process as ineligible for adjudication under that process. The IDRs upheld their challenges only 17 percent of the time. Health plans are starting to sue those submitting large numbers [...]

joe2026-03-24T16:48:35-04:00March 25, 2026|Uncategorized|

Federal Health Policy Update for March 19

The following is the latest health policy news from the federal government for March 13-19. Some of the language used below is taken directly from government documents. The White House President Trump has issued an executive order creating a Task Force to Eliminate Fraud that “…shall, on behalf of the President, coordinate and accelerate a comprehensive national strategy to stop fraud, waste, and abuse within Federal benefit programs, including programs administered jointly with State, local, tribal, and territorial partners.” The vice president will chair the task force, the Secretary of the Department of Health and Human Services is among its [...]

joe2026-03-19T15:41:48-04:00March 19, 2026|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare reimbursement policy|

CMS Plans IDR Changes

The Independent Dispute Resolution process that is the central implementation mechanism of the No Surprises Act will soon undergo reengineering. Working with the Labor Department and the Department of the Treasury, the Centers for Medicare & Medicaid Services plans to transition the IDR process from single-use web forms into a new IDR gateway later this year. Previewing a process that it anticipates officially unveiling in the near future, CMS notes that through this new gateway, users be able to start and respond to disputes; gain access to dispute dashboards and reports associated with their organization; track dispute information, including disputes [...]

joe2026-03-17T13:55:25-04:00March 18, 2026|Centers for Medicare & Medicaid Services|

Groups Protest No Surprises Act Implementation

A group of more than 60 health care payers, employer groups, and others have written to the departments of Health and Human Services, Labor, and the Treasury to protest how the Independent Dispute Resolution process created under the No Surprises Act is deciding pay disputes between providers and insurers. The letter accuses payers of using the Independent Dispute Resolution process as a money-making tool. It also maintains that the panels deciding the disputes are favoring providers – which are winning 85 percent of the cases they consider – and are operating without sufficient guidance from federal regulators. It also notes [...]

joe2026-02-25T13:05:12-05:00February 26, 2026|Uncategorized|

Federal Health Policy Update for February 19

The following is the latest health policy news from the federal government for February 13-19. Some of the language used below is taken directly from government documents. Congress Congress is not in session this week and will return on Monday, February 23. The House Ways and Means Committee will hold a hearing titled “Next Generation of Health Care Workforce” on Tuesday, February 24. View a livestream of the hearing here. The Courts A federal court has vacated the Federal Trade Commission’s (FTC) 2024 overhaul of the Hart-Scott-Rodino Premerger Notification Rule. That rule expanded disclosure requirements, requiring filings for transactions valued [...]

joe2026-02-19T15:40:16-05:00February 19, 2026|340b, Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicare, Medicare regulations|