Health system’s ‘proactive’ arbitration strategy under the No Surprises Act yields strong results

Houston-based Nutex Health achieved an independent dispute resolution success rate exceeding 80% in the fourth quarter after contracting a third-party vendor in July to recover out-of-network claims under the No Surprises Act.

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The physician-led network of microhospitals contracted with an undisclosed company to assist in the recovery of certain out-of-network claims under the arbitration process, according to an SEC filing published Nov. 7.

Nutex now submits 60% to 70% of billable visits to arbitration each month and is beginning to realize the financial impact of this strategy.

“Our proactive approach to arbitration under the No Surprises Act has yielded positive results thus far,” Nutex Chair and CEO Tom Vo, MD, said in a Feb. 5 news release. “We have been able to secure rightful payments for our facilities and providers while continuing to deliver high-quality, accessible care to our communities. 

Nutex said it cannot predict whether arbitration successes and claim recovery will continue at current levels and potential revisions to the federal IDR process may result in a decrease in claim amounts recovered in the future. 

However, “the momentum we have built in 2024 places Nutex Health in a strong position for continued success in the coming year,” Dr. Vo said. 

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