IDR entities have come to play an instrumental role in OON payments, but entities’ determinations and decision-making practices lack transparency. In their latest piece for Health Affairs Forefront, Kennah Watts and Jack Hoadley analyze variation IDR entities’ decision-making patterns and discuss the implications for the IDR process.
While the independent dispute resolution (IDR) process is intended to lead to fair outcomes for out-of-network payment, new analysis demonstrates unexpectedly high use of the IDR process, mostly by private-equity-backed providers that win often and win large. In their latest piece for Health Affairs Forefront, Jack Hoadley, Kennah Watts, and Zachary Baron illustrate trends in the IDR process and explore implications for costs.
On March 7, CHIR hosted the second event in a series of policy briefings on the future of employer-sponsored health insurance, sponsored by Arnold Ventures. This event, featuring remarks from Congressman “Bobby” Scott and a panel discussion moderated by Julie Appleby of KFF Health News, focused on the No Surprises Act’s impact on consumers and implementation challenges associated with the independent dispute resolution process.
Last month, the Biden administration reported on independent dispute resolution (IDR) cases resolved under the No Surprises Act in the first half of 2023. In a new post for the Commonwealth Fund, CHIR’s Jack Hoadley and Kevin Lucia analyze the IDR data and what it means for patients, providers, payers, and health care costs.
The No Surprises Act (NSA) provides comprehensive protections from many of the most prevalent forms of surprise medical billing, and a new process for determining out-of-network provider reimbursement aims to control health care costs by limiting insurer payments for surprise bills. It remains to be seen if the new federal law—implemented only last year—will achieve these goals. Two recently released reports provide some of the first indicators of the NSA’s impact.
The No Surprises Act is largely working as intended to protect patients from unexpected medical bills. However, the rising number of Independent Dispute Resolution (IDR) cases is creating challenges for the health care system. In a post for Health Affairs Forefront, Jack Hoadley and Kevin Lucia evaluate the causes and implications of the increasing number of IDR cases.
Under the No Surprises Act, consumers are held harmless beyond in-network cost sharing when they receive certain kinds of out-of-network care. In these scenarios, to determine the provider’s payment, payers and providers may enter independent dispute resolution (IDR). Recently, federal agencies released an initial report on the No Surprises Act’s IDR process. In a post for Health Affairs Forefront, CHIR experts Jack Hoadley and Kevin Lucia analyze the new report and discuss what it suggests about the No Surprises Act.
Welcome to another year of health policy research. In the first month of 2023, CHIR reviewed studies on how policies expanding health coverage would impact household spending, surprise medical bills generated by ground ambulance rides, and health care costs associated with substance use disorders.
On December 9, the Centers for Medicare and Medicaid Services announced the membership of the Advisory Committee on Ground Ambulance and Patient Billing, as required by the No Surprises Act (NSA). As the committee prepares to begin its work, there is new evidence out of Texas that the NSA’s exclusion of ground ambulance bills puts consumers at a significant financial risk when they need emergency medical transport.
The No Surprises Act (NSA) aims to protect consumers facing surprise medical bills after receiving care from out-of-network providers under circumstances beyond their control. In a new report for the Commonwealth Fund, CHIR experts look at how states are working with the federal government to implement this landmark law.
The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.
