Who is winning surprise billing disputes?

Providers, facilities and air ambulance companies prevailed in 77% of No Surprises Act payment determinations in the first half of 2023. 

Certified independent dispute resolution entities made payment determinations in 83,868 disputes during the first six months of 2023, according to a Feb. 15 report from CMS. 

Health plans and issuers were the prevailing party in 23% of payment determinations over that span, according to the report. 

The prevailing offer was higher than the qualifying payment amount in 82% of cases. Both parties submitted an offer and paid fees in 79% of cases, while only one party submitted an offer and paid fees in 21% of disputes.   

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

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. 

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