In this episode of Zotec Answers, Ed Gaines, Vice President of Regulatory Affairs and Industry Liaison at Zotec Partners, welcomes Dr. Tilden Childs, a board-certified diagnostic radiologist with Radiology Associates of North Texas and physician advocate, to answer the question: Physicians are winning in No Surprises Act disputes, but why are payers not paying? Together, Ed and Dr. Childs examine the growing challenges surrounding the No Surprises Act (NSA), including unpaid Independent Dispute Resolution (IDR) awards, limited payment enforcement, and the financial consequences for independent physician practices. Dr. Childs shares his group's experience winning 95% of federal IDR disputes while facing millions in unpaid awards. The conversation explores recent CMS audits revealing insurer noncompliance with qualifying payment amount (QPA) regulations, the potential impact of the Lower Premiums Faster Payments Act (H.R. 10788), and how the No Surprises Act Enforcement Act (H.R. 4710) could strengthen accountability. They also discuss why fair reimbursement, meaningful payer participation, and effective enforcement are essential to protecting independent medical practices and the future of patient care.
What happens when physicians win No Surprises Act payment disputes, but insurers fail to pay?
In this episode, Ed Gaines and Dr. Tilden Childs examine why unpaid IDR awards, disputed reimbursement calculations, and enforcement gaps continue to challenge physicians, independent medical practices, and the healthcare reimbursement system.
Key topics include:
Ed and Dr. Childs also discuss the role of the Texas Medical Association's lawsuits, the importance of physician engagement in healthcare legislation, and what stronger enforcement could mean for the long-term effectiveness of the No Surprises Act.
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