A group of Republican lawmakers is pressing the Trump administration to step up enforcement of the No Surprises Act, citing ongoing problems with implementation and the IDR process.
“We request the departments finalize clear and consistent QPA calculation methodology, accelerate enforcement of updated QPA calculations, and release the statutorily mandated QPA audits to ensure transparency and accountability,” the Sept. 5 letter to HHS, and the Labor and Treasury Departments, said. “Furthermore, the IDR Operations Rule, intended to correct claim eligibility and batching issues highlighted by the Committee, has still not been finalized despite being first proposed in October 2023.”
Five notes:
1. Per the letter, patients still lack access to advanced EOBs, the Independent Dispute Resolution process faces efficiency issues and payment delays, and there are ongoing problems with how Qualified Payment Amounts are calculated and weighted.
2. A 2024 survey of emergency physicians found that 24% of settled disputes were not paid or were paid an incorrect amount within the 30-day post-IDR payment timeline.
3. The No Surprises Act is tied to an 18% decline in out-of-pocket spending among adults with direct purchase private health insurance, according to a BMJ study published in August.
4. The IDR process has generated at least $5 billion in costs since its launch in 2022, largely due to high dispute volumes and provider wins, according to a study published in August in Health Affairs. In 2024, providers won 85% of disputes. Median payment determinations were 459% of QPA in the fourth quarter of 2024, up from 327% in 2023.
5. Large insurers, including UnitedHealthcare, Elevance and Aetna have been engaged in multiple legal disputes in recent years over the IDR process, broadly allegedly that providers are submitting high volumes of ineligible disputes in an effort to receive inflated payments.
