No Surprises Act dispute volume 13 times higher than estimated

There were 288,810 No Surprises Act disputes initiated during the first six months of 2023, which was 13 times greater than federal agencies initially anticipated, according to a Feb. 15 report from CMS. 

Six things to know:

1. There were 136,111 disputes initiated through the federal independent disputes resolution portal in the first quarter of 2023, up 24% from the fourth quarter of 2022, according to the report. There were 152,699 disputes initiated in the second quarter of 2023, a 12% increase over the first quarter. 

2. Ten parties were responsible for initiating 78% of all disputes in the first six months of 2023.  Many are — or are represented by — large practice management companies, medical practices or revenue cycle management companies representing hundreds of individual practices, providers or facilities. 

3. Three companies accounted for 58% of all initiated disputes, according to the report. They were SCP Health, Team Health and Radiology partners. 

4. Certified independent dispute entities rendered 83,868 payment determinations in the first six months of 2023, more than five times the number of determinations made in all of 2022 (16,238), the report said. 

5. The primary cause of delays for process disputes is the "complexity of determining whether disputes are eligible for the federal IDR process," according to the report. In the first six months of 2023, non-initiating parties challenged the eligibility of 106,038 disputes. Even when the disputes are not challenged, the IDR entity is still required to review the dispute and determine whether it is eligible before it can proceed in the process. These reviews require IDR entities "to expend considerable time and resources."  

6. A smaller percentage of disputes were determined to be ineligible in the first half of 2023 (22%) compared to 2022 (46%), according to the report. CMS attributed this to process improvement and disputing parties' greater familiarity with eligibility requirements.

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