Winning the IDR Award is Only Half the Battle: Enforcing No Surprises Act Reimbursement

For healthcare providers, the federal No Surprises Act’s Independent Dispute Resolution (“IDR”) process was intended to provide a mechanism for resolving payment disputes involving certain out-of-network services. But an increasingly important question is emerging after the arbitration concludes: What happens when a provider obtains an IDR award and the health plan still does not pay?

Recent reporting from Modern Healthcare has highlighted litigation surrounding unpaid No Surprises Act arbitration awards, illustrating a growing challenge for providers utilizing the federal IDR system. An award may establish the amount that should be paid, but providers may still face another collection problem when payment does not timely follow.

For revenue cycle leaders, this distinction is critical. Successfully navigating IDR and successfully collecting the resulting reimbursement are related—but potentially separate—parts of the recovery process.

Building the Case Before IDR Begins

Effective recovery starts well before an IDR entity selects an offer.

The No Surprises Act establishes a structured process for resolving qualifying out-of-network reimbursement disputes, including initial payment or denial, an open negotiation period, and, when the parties cannot agree, federal IDR. Each stage carries procedural requirements and deadlines that can affect a provider’s ability to pursue additional reimbursement.

Providers therefore need systems capable of identifying potentially eligible claims, monitoring deadlines, preserving relevant documentation, and developing support for the reimbursement amount being requested.

That analysis should extend beyond the individual claim. A provider experiencing repeated underpayments from the same payer may benefit from analyzing claims data collectively to identify recurring reimbursement patterns, common service lines, payment methodologies, and other evidence relevant to the dispute.

Abril Law assists providers in evaluating disputed claims and developing legal and reimbursement strategies designed to move qualifying accounts through the IDR process while preserving the documentation necessary for potential enforcement efforts.

When an IDR Award Does Not Produce Payment

Obtaining a favorable determination should represent a significant milestone in the reimbursement process. It should not create another aging receivable.

Federal law generally requires the additional amount owed pursuant to an IDR determination to be paid within 30 days after the determination. Yet the emergence of litigation concerning unpaid IDR awards demonstrates why providers should have a strategy for accounts that remain unpaid after that period.

At that point, the matter can shift from reimbursement advocacy toward legal enforcement.

The appropriate remedy is highly dependent upon the facts, applicable law, parties involved, and jurisdiction. An IDR determination should not simply be treated as though it were already a court judgment. Rather, counsel must evaluate the legal basis for seeking judicial relief and the procedural mechanism available to convert an unpaid reimbursement obligation into relief enforceable through the court system.

That distinction matters.

From IDR Enforcement to Judgment Collection

Where litigation results in an enforceable judgment, providers gain access to a fundamentally different collection framework.

Abril Law’s experience extends beyond healthcare reimbursement disputes into commercial litigation and post-judgment collection. That allows the Firm to approach unpaid reimbursement matters with the entire recovery lifecycle in mind: identifying the reimbursement dispute, pursuing available administrative remedies, evaluating litigation when payment does not follow, and, when a judgment is obtained, pursuing lawful post-judgment remedies.

Depending upon the circumstances and jurisdiction, post-judgment enforcement can include discovery directed toward identifying assets and financial relationships, garnishment proceedings, judgment liens, proceedings supplementary, and other collection remedies authorized by law.

For providers, the objective is straightforward: the recovery process should not stop merely because the payer has failed to voluntarily satisfy its payment obligation.

Treating IDR as Part of a Larger Recovery Strategy

The continuing evolution of No Surprises Act litigation highlights an important lesson for hospitals, physician groups, emergency providers, anesthesiologists, radiologists, and other organizations regularly treating out-of-network patients

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IDR should not be viewed as an isolated administrative event.

Instead, providers should develop a comprehensive recovery strategy that follows the claim from initial reimbursement through final collection. That means identifying IDR-eligible claims, meeting federal deadlines, developing defensible reimbursement positions, tracking favorable determinations, identifying unpaid awards, and escalating appropriate matters when voluntary payment does not occur.

The same data can also reveal a broader story. When multiple claims involving the same payer demonstrate recurring reimbursement or nonpayment patterns, providers and their counsel can evaluate those claims collectively rather than allowing each account to disappear independently into aging accounts receivable.

Abril Law: From Reimbursement Dispute Through Enforcement

Abril Law represents healthcare providers in reimbursement disputes involving commercial insurers and health plans, including matters arising from out-of-network reimbursement and the No Surprises Act. The Firm also represents businesses in litigation and post-judgment collection proceedings.

That combination is increasingly important.

A favorable IDR determination has limited practical value if the reimbursement never reaches the provider. When a payer does not satisfy its obligations, providers need counsel capable of evaluating not only how to pursue the underlying reimbursement dispute, but also what legal remedies may be available when payment does not follow.

For providers confronting significant volumes of disputed or unpaid out-of-network claims, the goal should not simply be to obtain an award.

The goal is recovery.

This article is provided for informational purposes only and does not constitute legal advice. The availability of IDR, judicial enforcement, and post-judgment remedies depends upon the particular facts, governing law, and jurisdiction.