Since the No Surprises Act took effect, in-network claim volumes have increased for key specialties while payment rates have largely followed pre-existing trends a new report finds.
For revenue cycle leaders, implementation of the No Surprises Act (NSA) in January 2022 created significant uncertainty. A primary concern was whether bans on balance billing and the introduction of the Independent Dispute Resolution (IDR) process would reduce provider participation in insurance networks or drastically alter contracted payment rates.
An analysis of private health insurance claims from 2019 through 2023 conducted by the Government Accountability Office (GAO), evaluated the impact of the NSA on four specialties prone to out-of-network billing: emergency medicine, radiology, anesthesiology, and air ambulance services. The results reveal that the NSA did not trigger a significant move away from payer networks or a significant drop in payment rates.
In-Network Participation is on the Rise
One of the most notable findings is that the percentage of in-network claims actually increased for three of the four evaluated specialties from 2021 to 2023. These include emergency medicine, anesthesiology, and air ambulance.
Air ambulance services saw the most significant increase in in-network claim percentages. Emergency medicine also saw a notable shift. The GAO analyzed over 61.5 million emergency medicine claims and found that while the percentage of in-network claims had been declining prior to the NSA, it rebounded and increased after the law took effect.
The report highlighted an important distinction between facility and professional claims. Facility claims consistently maintained higher in-network percentages than professional claims. However, professional claims saw a more significant positive shift in network participation post-NSA implementation.
Interviews with state insurance departments aligned with these findings, with officials from states like Texas and Washington confirming that network participation has either remained flat or increased since surprise billing protections were implemented.
Payment Rates Track Pre-Existing Trends
Post-NSA payment changes for the selected in-network services largely reflected a continuation of trends that existed prior to 2022.
For instance, inflation-adjusted payments for in-network emergency medicine services billed by facilities increased in 2022 and 2023, carrying forward a trajectory that began in 2019. On the other hand, inflation-adjusted payments for professional emergency medicine claims decreased during the same period, which also mirrored pre-existing downward trends. Air ambulance services were a slight outlier. While airplane transport payments decreased post-NSA, helicopter transport payment rates dipped in 2022 before increasing again in 2023.
Denial rates were also consistently higher for services rendered by out-of-network providers between 2019 and 2021, a pattern that has continued since the NSA took effect.
Takeaways for Revenue Cycle Leaders
The NSA has ultimately incentivized network participation rather than deterred it, according to the report. For out-of-network providers, the administrative burden and complexity of the IDR process, combined with persistently higher out-of-network denial rates, make in-network contracts an attractive option for revenue stability.
For revenue cycle executives, this underscores the importance of proactive payer contracting. As in-network participation grows among historically out-of-network specialties like anesthesiology and emergency medicine, health systems must leverage their scale to negotiate favorable, inflation-adjusted rates that protect professional and facility revenues alike.
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
In-network claim volumes increased post-NSA for historically out-of-network specialties like emergency medicine and anesthesiology, showing the law did not drive providers away from payer contracts.
Payment rates for in-network services have largely followed pre-existing, pre-NSA trajectories, despite earlier fears that the new regulations would lead to lower contracted reimbursement.
The administrative burden of the IDR process and persistently high out-of-network denial rates make in-network participation an attractive and stable option for revenue cycle leaders.