No Surprises Act disputes hit 'logjam' as lawsuit looms

The Texas Medical Association's lawsuit challenging the validity of the No Surprises Act's independent dispute resolution could increase an already lengthy backlog, Bloomberg Law reported Nov. 28. 

Five things to know:

1. HHS launched the independent dispute resolution portal in April and received more than 90,000 claims in the first five and a half months. A CMS spokesperson told Bloomberg Law that figure is "substantially more than the department initially estimated would be submitted for a full year." 

2. Claire Ernst, director of government affairs at the Medical Group Management Association, told Bloomberg Law some claims have been pending for eight or nine months.

"That's eight or nine months you're not getting paid," she said. 

3. Because the independent dispute resolution process is new, there is uncertainty about whether it will favor insurers, providers or end up somewhere in between. Jeremy Hays, who represents employers in disputes as counsel at Ogletree Deakins, told the outlet that parties are less likely to settle disputes amicably when they cannot predict the dispute's outcome.

4. Mr. Hays also said each time the independent dispute process changes, arbitrators have to reconsider their methodologies to ensure they align with federal guidance. He said that is likely slowing down processing time and could happen again if the court decides further revisions to the rule are needed. 

5. A federal court in Texas will hear arguments over the validity of the independent dispute resolution process Dec. 20. Mr. Hays said if the court strikes down the rule, long delays in claim resolution and additional costs associated with the process likely will continue. 

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