CMS released the Federal No Surprises Act Independent Dispute Resolution (IDR) Q1 and Q2 2025 public use files and supplemental tables Jan. 21.
The files and supporting information illustrate that providers continue to prevail in the vast majority of IDR claims, with 88% of disputes found in their favor. In addition, 87% of the award amounts exceeded the qualifying payment amount (QPA) or median in-network rate as calculated by the payers. These materials fulfill statutory reporting requirements to provide quarterly transparency into IDR program activity.
In addition, the U.S. Departments of Health and Human Services, Labor, and the Treasury announced the certification of a new IDR entity, Dane Street, LLC. Expanding the number of certified IDR entities from 15 to 16 is expected to increase IDR throughput and reduce an ongoing backlog of determinations.
Sens. Bill Cassidy, MD (R-LA), Chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, and Maggie Hassan (D-NH), sent a communication to HHS expressing support of the agency’s efforts to improve implementation of the NSA and urging HHS to finalize pending rules designed to improve IDR operations. Specifically, they encouraged the agencies to focus on policies that will remove ineligible disputes from the system.
For more information or if you have questions about the No Surprises Act, contact Katie Keysor, ACR Senior Director of Economics and Health Policy.
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