The No Surprises Act (NSA) continues to be a hot topic in healthcare policy, and recent advocacy efforts have brought critical issues to light. A major concern raised by the American College of Emergency Physicians (ACEP) and the Emergency Department Practice Management Association (EDPMA) is the increasing trend of insurers submitting final offers of zero dollars in independent dispute resolutions (IDRs). This troubling pattern not only affects reimbursement for emergency services but also raises legal concerns regarding compliance with the Affordable Care Act (ACA) and Prudent Layperson Law (PLP).  

On a positive note, physicians recently had the rare opportunity to discuss these challenges directly with the Secretary of Health and Human Services, Robert F. Kennedy Jr. The Secretary, along with key officials from the Centers for Medicare and Medicaid Services (CMS) and the Center for Consumer Information and Insurance Oversight (CCIIO), expressed concern over insurers’ failure to comply with the NSA-mandated IDR payments—an issue that has been widespread. This meeting highlighted the urgent need for enforcement measures, with discussions referencing a congressional bill aimed at penalizing noncompliant health plans. Additionally, improvements to the IDR process, including better claim tracking and portal functionality, were emphasized as crucial next steps.  

While these discussions mark progress, change takes time. The hope is that recent advocacy efforts will prompt swift action from regulators to enforce compliance and enhance the IDR system. As updates unfold, staying informed is key. For a deeper dive into these critical issues, listen to the latest episode of the Zotec Answers podcast, where we break down these developments in greater detail.