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CMS finalized a new rule aimed at streamlining the No Surprises Act’s overwhelmed arbitration system. Provider groups largely welcomed the reforms — though some industry leaders said additional changes are still needed to address alleged misuse and improve transparency.
The Centers for Medicare and Medicaid Services finalized a new rule on Thursday to improve the federal independent dispute resolution (IDR) process under the No Surprises Act. The update is designed to reduce costs and administrative burden for both providers and payers, the agency said.
The No Surprises Act, which went into effect in 2022, seeks to protect Americans from unexpected medical bills by banning many forms of surprise billing for out-of-network emergency care. It also established a federal arbitration process for payer-provider disagreements over out-of-network payment amounts. Both providers and payers have expressed frustrations with the current IDR process, with complaints about high administrative fees, long delays and a growing backlog of disputes.
CMS said there have been more than 5 million disputes since the No Surprises Act went into effect. This is far more than the agency had expected — it originally estimated it would be handling about 17,000 disputes per year.