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EDPMA Study Reveals 32% Decrease in OON payments due to the flawed implementation of the No Surprises Act

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We strongly believe that emergency physicians should be fairly reimbursed for the delivery of emergency care, and payers should do their part to not undermine the emergency medical health care delivery system and the overall health of our healthcare system.


MCLEAN, Va. (PRWEB)

Emergency departments are experiencing a 32% decrease in out-of-network payments from health plans since the implementation of the No Surprises Act (NSA), according to a new study from the the Emergency Department Practice Management Association (EDPMA). This dramatic reduction significantly risks how emergency departments deliver emergency care.

With the NSA being in place for one year, EDPMA commissioned a study of its members to understand the real-world impact of the federal law designed to keep patients out of the middle of payment disputes. While it appears the NSA achieved its goal to protect patients, the flawed implementation of the legislation threatens how emergency departments are staffed and could jeopardize the emergency care patients deserve.


  • 91% of claims surveyed did NOT include an identified Qualified Payment Amount (QPA) as required by law. There is no known enforcement to this pervasive health plan non-compliance.

  • Post-NSA out-of-network payments decreased 92% of the time (compared to Pre-NSA rates) resulting in an average decrease of 32% per emergency department visit. This abrupt, dramatic reduction greatly risks how emergency departments are staffed and how patients receive emergency care.

  • The QPA consistently equals the allowed amount for provider payments meaning that health plans are regularly using a problematic QPA amount when the NSA clearly indicates that the QPA should not be the sole payment standard.

  • If the current NSA implementation goes unchecked, American emergency medicine practices are expected to lose almost $1 billion each year thereby crippling emergency departments and risking access to emergency care. Emergency departments serving rural and underrepresented communities are especially at risk.

EPDMA is committed to a viable and sustainable No Surprises Act implementation. We continue to offer solutions, input, and data to the Department of Health and Human Services, the Department of Labor, and the Department of Treasury to promote:

  • Rapid and effective enforcement

  • Require and clarify RARC codes

  • Ensure accurate QPAs

  • Encourage continued Congressional involvement

  • Sustain patient protections under EMTALA

See the study summary here.

“We strongly believe that emergency physicians should be fairly reimbursed for the delivery of emergency care, and payers should do their part to not undermine the emergency medical health care delivery system and the overall health of our healthcare system. EDPMA is in the business of emergency medicine and will continue to advocate for its members and patients,” says Don Powell, DO, FACEP, EDPMA Chair of the Board.

About EDPMA

The Emergency Department Practice Management Association (EDPMA) is the nation’s only professional physician trade association focused on the delivery of high-quality, cost-effective care in the emergency department. EDPMA’s membership includes emergency medicine physician groups of all sizes, as well as billing, coding, and other professional support organizations that assist healthcare providers in our nation’s emergency departments. Together, EDPMA’s members deliver (or directly support) health care for about half of the 146 million patients that visit U.S. emergency departments each year. Visit http://www.edpma.org.

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