Comprehensive Resources for the No Surprises Act
Access our library of tools, information, and expert guidance to better understand how the NSA affects your practice and how the IDR process can help you secure fair compensation.
Understanding the No Surprises Act
The No Surprises Act, enacted in December 2020 as part of the Consolidated Appropriations Act of 2021, protects patients from unexpected medical bills when they receive emergency services or non-emergency services from out-of-network providers at in-network facilities.
While the patient protections are essential, the law's Independent Dispute Resolution (IDR) process has created challenges for physicians seeking fair compensation. The legislation establishes a "baseball-style" arbitration system where both providers and insurers submit their best payment offers, and an independent arbitrator selects one.
Our resources will help you understand the NSA's provisions and how to effectively navigate the IDR process to ensure you receive appropriate payment for your services.
Common Questions About the No Surprises Act
This FAQ section is tailored to offer clear answers regarding the arbitration process under the No Surprises Act. Familiarize yourself with key topics and find solutions to your queries.
What types of services are covered by the No Surprises Act?
The NSA applies to emergency services, post-stabilization care, and non-emergency services provided by out-of-network physicians at in-network facilities. This includes hospital-based specialists like anesthesiologists, radiologists, pathologists, emergency physicians, and neonatologists who may not have contracts with all insurers that contract with the facility.
How does the Independent Dispute Resolution (IDR) process work?
The IDR process follows these key steps:
1. A 30-day open negotiation period with the insurer must be initiated within 30 business days of receiving the initial payment or denial
2. If negotiation is unsuccessful, either party can initiate IDR within 4 business days after the negotiation period ends
3. Both parties submit their offers and supporting documentation
4. A certified IDR entity reviews the submissions and selects one of the offers as the binding payment amount
What is the Qualifying Payment Amount (QPA) and why is it important?
The QPA is the insurer-calculated median in-network rate for similar services in a geographic region. While initially intended to be the primary factor in IDR decisions, court rulings have required arbitrators to consider multiple factors beyond the QPA, including:
1. Provider's training and experience
2. Market rates and previous contracted rates
3. Complexity of the case
4. Teaching status, case mix, and scope of services of the facility
How successful is the IDR process for physicians?
Recent data shows providers win approximately 86% of arbitration cases, with payment determinations averaging 2-3 times higher than the insurer-calculated QPA. However, success requires proper documentation, strategic case selection, and expertise in the IDR process.
Does my medical practice need legal representation for the IDR process?
While not required, legal representation significantly improves outcomes by ensuring proper documentation, adherence to strict timelines, and development of compelling evidence packages. The IDR process involves complex regulatory requirements that continue to evolve with ongoing litigation and rule changes.
How long does the entire IDR process take?
From initiating open negotiations to receiving payment typically takes 3-4 months. The 30-day negotiation period is followed by the IDR submission and selection process (approximately 30 days), and then payment must be made within 30 calendar days of the determination.
Reclaim What You've Earned
Insurance companies use the No Surprises Act to underpay physicians. Our legal experts win higher payments through strategic IDR representation every day.
