9 steps to collect after you win No Surprises Act arbitration

Winning a federal arbitration case over an out-of-network bill is supposed to settle the argument. For a lot of practices, it only starts a new one. When CMS Administrator Mehmet Oz and officials from the departments of Labor and Treasury sat down Oct. 1 with leaders of all 17 certified independent dispute resolution (IDR) entities, late payment or nonpayment after decisions was one of the problems on the table, according to CMS' meeting summary.

The stakes are not small. The federal process has closed more than 7 million disputes since April 2022, and providers win about 80 percent of them, according to Becker's Payer Issues, citing an Elevance Health Public Policy Institute analysis. The law gives the losing side 30 calendar days to pay after a determination. But on Sept. 17, the 2nd U.S. Circuit Court of Appeals refused to revive a practice's bid to collect more than $3 million in unpaid awards from Cigna, ruling that the No Surprises Act leaves enforcement to regulators.

That turns collection into an operations problem. If the courts won't make a payer pay, the practice with the cleanest records and the most persistent follow-up is the one that sees the money. Here are nine steps to get there.