A recent survey by the Emergency Department Practice Management Association (EDPMA) has confirmed what many emergency medicine groups have already experienced firsthand: a significant drop in out-of-network reimbursement since the No Surprises Act (NSA) took effect.
According to the survey, emergency physician groups have seen a 39% reduction in out-of-network payments—a financial shift that has widespread implications for the sustainability of emergency care.
Let’s break down what this means and how practices can respond.
The Reality Behind the Numbers
The NSA was designed to protect patients from unexpected medical bills—but the resulting policy changes have placed a new financial burden on emergency providers.
- 39% decline in out-of-network reimbursement
- Decreased payer negotiation leverage for ED groups
- Rising operating costs with shrinking margins
- Increased use of the Independent Dispute Resolution (IDR) process as payment disagreements escalate
While the intention behind the NSA was patient protection, emergency departments—often serving patients without the luxury of network selection—are being disproportionately affected.
The Financial Pressure on Emergency Medicine Providers
Emergency departments operate 24/7 and often treat the most acute, high-risk patients. These services come with higher operational costs, and many freestanding ERs and physician groups rely on a mix of in-network and out-of-network reimbursement to stay financially viable.
When payers reduce or delay out-of-network payments:
- Cash flow slows
- Staffing and resource decisions become constrained
- Revenue cycles face increased administrative burdens
These financial challenges are amplified when groups must navigate the complex IDR process—often without the data, documentation, or bandwidth to do so effectively.
Final Thoughts
The EDPMA survey underscores a hard truth: the NSA has shifted the reimbursement landscape, and emergency providers must be proactive in protecting their financial stability. With nearly 4 in 10 dollars disappearing from out-of-network payments, emergency medicine groups need partners who understand the stakes—and how to respond strategically.
QMACS is that partner.
If your practice has been impacted by the No Surprises Act, we’re here to help. Let’s talk about how to safeguard your revenue and strengthen your RCM operations.
Contact QMACS today to learn more.