The enforcement of payment awards under the No Surprises Act (NSA) Independent Dispute Resolution (IDR) process was the focus of a critical hearing before the Fifth Circuit this past Monday. At the heart of the issue is whether Congress intended for courts to provide relief when insurers fail to pay IDR awards—or if providers must pursue other methods to collect on binding awards including the use of the Federal Complaint Portal. The outcome of this case could reshape how providers recover unpaid awards, a growing problem in the wake of delays in payment awards. Despite awards being final and binding and due within 30 days of the determination, there are mixed results in the rights of providers to pursue enforcement through the Courts. A Fifth Circuit ruling in favor of providers allowing for enforcement on binding awards through the Courts could strengthen the ability of providers to receive timely payment.
The Road Ahead: Legal or Legislative Enforcement
In addition to the case pending in the Fifth Circuit Congress has been considering legislative measures to strengthen NSA enforcement, including harsher penalties for insurers that fail to pay IDR awards on time and increased reporting requirements for oversight agencies. While members of Congress have introduced bills seeking to address the issue, it is unclear as to if and when these matters will be considered going forward.
CHRMS continues to closely monitor these proceedings and remains committed to keeping providers informed of regulatory changes impacting reimbursements. Please reach out with any questions.