Research Proves No Surprises Act Has Consequences

EDPMA Billing statement

Research Proves No Surprises Act Has Consequences

The No Surprises Act (NSA), enacted by the federal government in 2020, was intended to protect patients from surprise medical bills. However, it has had unforeseen consequences on healthcare providers. The results of a study conducted by the Emergency Department Practice Management Association (EDPMA) reveal some startling statistics about the effectiveness of Independent Dispute Resolution (IDR) under the NSA.

 

No Surprises Act Study Results from EDPMA

According to EDPMA’s research, up to 87% of IDRs are being rejected by payers due to various technical grounds such as submission type or timing issues. Additionally, only 8% of claims that go through IDR result in payment above what payers initially offered. This means most providers receive less than they would have before the NSA.

Further, 91% of claims filed through the IDR process remain open and unadjudicated and almost 96% of these outstanding claims are 5+ months old. The study also states that payers ignoring claims in the open negotiation period contribute to the significant volume of IDR claims.

Lastly, an IDR entity decision favoring providers does not necessarily lead to recovered revenue: 86% of payers have not paid in accordance with the IDR entity’s decision.

 

What the No Surprises Act Means for Providers and Revenue Cycle Management

These statistics indicate a significant lack of effectiveness in the IDR process under the NSA. EDPMA found that providers spend time and resources preparing IDRs when it is more likely than not that those claims will be rejected or result in payment below what was offered initially. This has resulted in unpaid bills for healthcare providers and a financial strain on their practice.

The unintended consequence of the No Surprises Act has put healthcare providers at an unfair disadvantage, leaving them to bear the brunt of unexpected costs while payers are able to avoid responsibility. The data from EDPMA’s study shows that something must be done to ensure fairness and equity within the system. Otherwise, healthcare providers will continue to suffer financially and patients’ access to quality emergency care is at risk. It is imperative that payers and providers work together to address this issue, or else healthcare providers will be left worse off than before.

 

Further information about the No Surprises Act

For more information on the impact of the No Surprises Act, please refer to the EDPMA’s full report. It is clear that something must be done in order to protect healthcare providers and ensure fairness within the system. Without action, the No Surprises Act will continue to cause harm to providers throughout the country.

By collaborating with Allia Group, your emergency physician group can recover out-of-network revenue successfully without experiencing IDR process challenges.

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