Providers won over 7 in 10 NSA payment disputes in first half of 2023, CMS data show

The Centers for Medicare & Medicaid Services Feb. 15 released to the public as required by law certain data submitted by disputing parties and certified independent dispute resolution entities to the No Surprises Act federal IDR portal for the first two quarters of reporting year 2023. The files include data on payment determination outcomes for out-of-network emergency and non-emergency items and services and air ambulance services, and data on qualifying payment amounts and offer amounts.

Among specific findings, the data show that health care providers and facilities won 72% of the 24,305 payment disputes where a payment determination was made involving out-of-network emergency and non-emergency items and services in first-quarter 2023; and 79% of the 53,806 payment disputes where a payment determination was made involving these items and services in second-quarter 2023. In the first quarter of 2023, 129,121 disputes were initiated, 129,040 by providers and facilities, and 48,486 disputes were closed; in the second quarter, 145,311 disputes were initiated, 145,269 by providers or facilities, and 76,341 disputes were closed. Disputes were closed primarily due to a payment determination being made, though some were closed because the dispute was found ineligible or for other reasons.