Now is the time to get involved—whether it’s sharing data for member surveys, submitting feedback on your current IDR experiences, or engaging in grassroots advocacy. Every action counts!

Dr. Brault is the immediate past Chair of the Emergency Department Practice Management Association. She is also current Chair of the ACEP Coding and Nomenclature Committee (Group 1) and a member of the ACEP Reimbursement Committee.

Footnotes

1. In August 2024, EDPMA captured data from a member survey related to the IDR process of the NSA. The survey period included January 1, 2024, through June 30, 2024. In this survey, EDPMA members reported the average time from entering the portal to the IDR initiation. The average timeline was 164 days, a 22 percent improvement compared with the 211 days reported in EDPMA’s Deep Dive Survey in 2023.
2. Data from CMS’ quarterly “Supplemental Background on Federal IDR Public Use Files (PUF)” shows a prevailing rate greater than 85 percent for physician/hospitals/air ambulance providers in 2024 (86 percent in Q1/Q2, 85 percent in Q3/Q4). The NSA requires the Department of Health and Human Services, Labor, and the Treasury (the Departments) to publish this information each calendar quarter. https://www.cms.gov/nosurprises/policies-and-resources/reports
3. The August 2024 EDPMA Survey found a worsening pattern of non-compliance among health plans following IDR payment determinations. Non-payments after an IDR determination jumped from 24 percent in 2023 to 69.2 percent in 2024. Incorrect payments also rose from 2.8 percent to 8.3 percent during the same period.
4. The August 2024 EDPMA Survey found that 2.5 percent (760 instances) of respondents received communication that changed the patient cost-sharing amount after the health plan did not prevail in IDR, despite the law making it clear that the amount owed by patients may never change as a result of the IDR process.
5. The NSA provides for two types of health plan QPA audits: (1) shall conduct audits based on samples (per year up to 25 group health/individual governed by 42 U.S. Code § 300gg–111 and up to 25 group health plans as governed by 26 U.S. Code § 9816); and (2) may conduct audits in response to complaints; to date, Departments have only announced complaint-based audits. Current reports present data from just CMS on enforcement, providing an incomplete picture of NSA enforcement efforts.
6. Physician advocates propose adopting policies included in the IDR Operations proposed rule. The proposed rule was released on October 27, 2023, and included requiring the use of existing RARC/CARC codes that communicate state versus federal jurisdiction. According to CMS’ IDR PUF report data (as of May 28, 2025), the primary cause of delays in processing disputes is the complexity of determining whether disputes are eligible for the Federal IDR process.
7. The Departments have created a few avenues to submit complaints and request assistance for non-compliance. However, since states, the Department of Labor, and the Department of Health and Human Services all share responsibility for enforcement, complaints do not consistently filter to the appropriate federal or state entity responsible for enforcement. Many physicians receive no response or are asked to re-route their complaint months later.
8. Earlier this year, CMS paused the resolution of payment disputes where a health plan submits a “$0.00” offer in the IDR process. CMS has since instructed the IDREs to resume processing these disputes, but physicians continue to urge CMS to explicitly direct IDR entities to treat a “$0.00” offer as a non-offer, which would result in a default win for the physicians’ submitted amount.