The No Surprises Act was designed to protect patients from unexpected medical bills, and it has largely succeeded in that goal. But the Independent Dispute Resolution (IDR) process is beginning to show signs of strain.

In cases like Anthem v. Prime Healthcare, some provider organizations appear to be submitting large numbers of ineligible claims, resulting in arbitration awards far above what in-network providers would receive. With providers prevailing in 80–85% of cases, it raises questions about whether the process is functioning as intended.

In an interview with Marissa Plescia, Managing Partner Michael Abrams noted that these cases may result in a careful reexamination of the IDR process to ensure it meets its original objectives.

I think one of the consequences of these cases may be to accelerate reexamination of the IDR process, raise questions about whether it’s really functioning the way it was meant to.

Read the full story on MedCity News.