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The No Surprises Act (NSA) was a landmark piece of legislation aimed at protecting patients from unexpected medical bills. One of the key components of the NSA is the independent dispute resolution (IDR) process, which allows medical providers and payors to resolve payment disputes through arbitration. The IDR process has generated hundreds of thousands awards for medical providers, which has subsequently led to a rise in litigation against managed care payors. This article explores the reasons behind this surge, the current state of litigation, and the prospects for further legal battles in 2025.
Under the NSA, providers who are dissatisfied with the payment they receive can initiate negotiations with the payor concerning the out-of-network rate for certain surprise medical bills. If negotiations fail, either party can initiate the IDR process. The IDR process uses a blind, “baseball-style” arbitration where the provider and the payor each submit an offer to a certified independent dispute resolution entity (CIDRE). The CIDRE reviews the parties’ offers and selects one party’s offer as the out-of-network rate.
The NSA provides that the CIDRE’s decision is “binding” and that payment “shall be made . . . not later than 30 days after the date on which such determination is made.” The NSA further specifies that judicial review is only allowed under Section 10(a) of the Federal Arbitration Act (FAA), which permits a party to seek to vacate an arbitration award under limited circumstances. The NSA does not expressly provide a mechanism for prevailing parties to enforce IDR awards.
- Provider lawsuits seeking to enforce IDR awards are expected to increase
- At least one appellate court will decide whether providers may enforce IDR awards under the No Surprises Act
- Congress may also step in to enhance enforcement of IDR awards