IDR Process Performance: Mid-2024 Review
- The No Surprises Act, enacted in 2022, shields consumers from unexpected medical bills by establishing a process that removes patients from payment negotiations between providers and insurers.
- A third-party arbitrator then reviews evidence from both sides to determine a final payment rate.
- The analysis found that emergency room care accounted for nearly two in three disputed services.Providers and their billing consultants initiated the majority of disputes, submitting 72% of out-of-network...
The No Surprises Act aims to protect patients—but is it working? A new report reveals key insights into the impact of the autonomous dispute resolution (IDR) process on medical billing, shedding light on its effectiveness and potential unintended consequences. Analysis shows emergency room services dominate disputes, with providers and billing consultants—many backed by private equity—driving the majority of claims. While patients are shielded from surprise bills, the Act may not be lowering overall healthcare costs.News Directory 3 delivers the vital statistics, examining the Act’s early impact. Discover what’s next for the future of medical billing and consumer protection.
No Surprises Act’s Impact on Medical Billing Examined
Updated May 30, 2025
The No Surprises Act, enacted in 2022, shields consumers from unexpected medical bills by establishing a process that removes patients from payment negotiations between providers and insurers. When negotiations fail, an independent dispute resolution (IDR) process is initiated.
A third-party arbitrator then reviews evidence from both sides to determine a final payment rate. A new analysis examines the implementation of the IDR process and its effects on providers, payers, and consumers.
The analysis found that emergency room care accounted for nearly two in three disputed services.Providers and their billing consultants initiated the majority of disputes, submitting 72% of out-of-network payment disputes from 2023 to mid-2024. TEAMHealth, SCP Health, and Radiology Partners—all backed by private equity—accounted for 53% of these disputes.
While the No Surprises Act is protecting consumers from surprise bills, it is likely not reducing prices and spending related to medical billing.
What’s next
ongoing monitoring and assessment of the No Surprises Act’s impact on healthcare costs and provider behavior are crucial to understanding its long-term effects.