The Coalition Against Surprise Medical Billing and the ERISA Industry Committee are asking the CMS to stop approving arbiters until it implements more rigorous standards.

The NSA was passed in 2020 to protect patients from unexpected out-of-network medical bills. But the law’s arbitration process, in which designated mediators resolve payment disputes between insurers and providers, has raised disputes of its own.

Insurers and providers have particularly been at loggerheads over independent dispute resolution, with each side arguing that it unfairly advantages the other. But federal data suggests providers are reaping outsized awards from IDR. Doctors and medical groups have filed significantly more disputes than regulators expected — more than 2.5 million disputes have been initiated from January through September of this year alone — and win about 80% of cases.

That volume, along with sky-high awards, has riled up policymakers concerned that IDR is driving up healthcare costs. The process spurred more than $22 billion in excess spending during its first four years, according to Georgetown University researchers.

According to the CASMB, which represents employer groups, unions and insurers, IDREs are a central driver of the broader dysfunction in the federal IDR system. That stance is supported by some research showing that IDREs routinely favor providers, and appear to be financially motivated to do so: Arbiters are paid by dispute, and receive no reimbursement if a dispute is deemed ineligible.

As a result, they’re incentivized to find disputes eligible, and rule in favor of providers so they keep filing them.

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