Health care providers are winning more than 86 percent of the emergency care payment disputes they take to adjudication through the Independent Dispute Resolution process established under the 2020 No Surprises Act.

The abstract of the article “No Surprises Act independent dispute resolution outcomes for emergency services,” published by the journal Health Affairs Scholar, explains that

The No Surprises Act banned surprise billing and established a final-offer arbitration system, independent dispute resolution (IDR), to resolve disagreements between health plans and providers. One factor that arbiters must consider in the IDR process is the qualifying payment amount (QPA), the median contracted rate for the same or similar service in the same market as computed by health plans. We analyzed public IDR data from 2023 for the most common disputed professional service: evaluation and management of a moderate to severe emergency medicine visit. Providers won 86% of cases, with mean decisions 2.7 times the QPA. Private equity-backed providers won more often and higher monetary awards than other providers. The mean QPA was 2.4 times Medicare payments. Disputes were dominated by a small group of health plans and providers, so payments may not reflect the overall market for emergency services.

Learn more from the Health Affairs Scholar article “No Surprises Act independent dispute resolution outcomes for emergency services.”