The No Surprises Act, which went into effect on January 1, 2022, protects patients from surprise out-of-network medical billing and creates an independent dispute resolution (IDR) process that resolves payment disputes between payers and providers. Since the Act went into effect, several lawsuits have been filed surrounding issues with the IDR ruling.
Courts Reject No Surprises Act IDR Rule – What Does This Mean for Providers and Payers?
The No Surprises Act has created tension between payers and providers since it took effect on January 1 2022. Barely six weeks later, on February 23, 2022, the U.S. District Court for the Eastern District of Texas struck down the part of the interagency interim final rule implementing the independent dispute resolution (IDR) procedures. IDR occurs when payers and out-of-network providers cannot agree on reimbursement. Matthew Albright, Chief Legislative Affairs Officer at Zelis, and Cate Brantley, Legislative Analyst at Zelis, discuss this topic future on a recent Future Healthcare Today podcast.
To listen to the podcast, click here.
The Six Provider Lawsuits Filed Over the No Surprises Act: Latest Developments
Providers have been aggressive in filing challenges to the No Surprises Act. There are currently six lawsuits in five different jurisdictions concerning the interpretation of the IDR rule. The goal of the providers is to use the federal IDR process to obtain higher out-of-network payments when doing so is not warranted. This could lead to higher health care costs and premiums for consumers, employers, and taxpayers.
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No Surprises Act Besieged by Lawsuits
Health plans and providers are working towards implementing transparency regulations and requiring hospitals and plans to publish the cost of basic medical procedures and services. Fewer than 15 percent of hospitals are compliant with these regulations that went into effect at the beginning of 2022. With the transparency requirements and the No Surprise Act in place, there will be more attention on hospital prices and health plan reimbursements.
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