The No Surprises Act, which went into effect in 2022, prohibits out-of-network healthcare providers from sending “surprise bills” to patients with private health insurance and creates an independent resolution dispute process for providers and payers.
According to a Feb. 19 report by the Government Accountability Office, the percentage of in-network claims increased for three out of four specialties most likely to be affected by NSA protections—emergency medicine, radiology, anesthesiology and air ambulance.
The GAO report analyzed claims data for more than 110 million patients from 2019 to 2023, evaluating the rate of change in network participation by physicians in the selected specialties.
Here are five takeaways from the study:
1. The GAO found that the percentage of in-network facility claims (typically submitted by hospitals) and professional claims (typically submitted by physicians) for emergency medicine declined before the No Surprises Act took effect, then increased afterward.
2. The study analyzed 18 million professional anesthesiology claims, which were billed by physicians and certified registered nurse anesthetists in 98% of cases. The percentage of in-network professional anesthesiology claims declined slightly before the NSA went into effect, and increased afterwards. In comparison, the percentage of in-network professional claims for family medicine remained relatively unchanged over the study period.
3. The study also analyzed these claims separately across three different practice settings: ASCs, inpatient hospitals and outpatient hospitals. Claims for services in ASCs saw the biggest change, declining from 96.8% to 94.4% in-network between 2019 and 2021 and returning to 96.8 in 2023, after the NSA’s implementation.
4. Representatives from all provider associations for the selected specialties in our review told the GAO that network participation for their specialties had likely remained the same or declined after the No Surprises Act protections went into effect.
5. Representatives from one organization told the GAO that no members reported increased network participation after the act went into effect. That association also said their members participated in a survey, and more than 80% of the survey respondents said they had at least one contract terminated after the NSA went into effect. However, representatives from another association noted that contract terminations, while initially a concern, had leveled off for their specialty after the act’s initial implementation period
