Medical billing has become increasingly complex, particularly when a healthcare provider and an insurance company disagree about how much a service should be reimbursed.
One area receiving renewed attention in 2026 is the No Surprises Act and the federal process used to resolve certain payment disputes between providers and insurers.
The law was designed to protect patients from unexpected out-of-network medical bills in specific circumstances. At the same time, it established a federal dispute resolution process that allows eligible providers and insurers to challenge certain payment amounts.
Recent reporting shows that the federal arbitration system has experienced substantial growth in disputes. The increase has generated debate among insurers, providers, patient advocates, employers, and policymakers about how the process is functioning and what its financial consequences may be.
For medical practices, understanding the basics of the No Surprises Act and keeping accurate billing documentation can be important when navigating out-of-network situations and payment disagreements.
What Is the No Surprises Act?
The No Surprises Act is a federal law intended to protect patients from certain unexpected out-of-network medical bills.
Among other provisions, the law addresses situations involving emergency services and certain non-emergency services provided by out-of-network providers at in-network facilities.
The law also established requirements surrounding good faith estimates for certain uninsured and self-pay patients and created a process for resolving eligible payment disputes between healthcare providers and health plans.
Importantly, the law does not mean that every disagreement between a provider and an insurance company automatically goes through federal arbitration.
Eligibility depends on the circumstances and applicable requirements.
Why Is the No Surprises Act Trending in 2026?
The payment dispute process has become a significant issue within healthcare revenue cycle management.
Recent reporting indicates that disputes submitted through the federal process have grown substantially, prompting discussion about whether the system is operating as intended and whether changes are needed. Patient advocacy groups, employers, insurers, and providers have expressed different concerns about the financial impact of the arbitration process.
This matters to medical practices because reimbursement disputes can consume administrative resources.
When a provider believes an insurance payment does not appropriately reflect the applicable circumstances, resolving the issue may require detailed documentation, careful review, and familiarity with the applicable process.
The Patient Protection and the Provider Payment Issue Are Connected
One of the important aspects of the No Surprises Act is that it addresses two related concerns.
The first is the patient’s protection from certain unexpected out-of-network bills.
The second involves the payment relationship between providers and insurers.
These are not necessarily the same issue.
A patient may be protected from receiving an unexpected balance bill while the provider and payer still have a disagreement about the appropriate reimbursement amount.
This distinction is important for medical practices because the provider’s ability to pursue payment from an insurer does not automatically mean the provider can transfer the disputed amount to the patient.
What Is the Independent Dispute Resolution Process?
The No Surprises Act created an Independent Dispute Resolution (IDR) process for certain eligible payment disputes between providers and health plans.
In broad terms, when a qualifying dispute cannot be resolved through the required preceding steps, the parties may be able to submit the dispute to an authorized dispute resolution entity.
The process involves reviewing information relevant to the payment dispute and determining the appropriate outcome under the applicable federal requirements.
Because the process has specific eligibility rules, timelines, documentation requirements, and administrative procedures, practices should not assume that every underpaid or disputed claim qualifies.
Why Documentation Matters
A payment dispute is only as strong as the information available to support it.
Medical practices should maintain organized records related to the services involved in a dispute.
Depending on the circumstances, relevant information may include:
- Patient and insurance information
- Date of service
- Provider information
- Procedure codes
- Medical documentation
- Claim information
- Payer communications
- Payment information
- Explanation of benefits
- Contract or network information when applicable
- Good faith estimates when relevant
- Records of previous payment discussions
- Documentation related to the dispute process
The exact information required will depend on the type of dispute and applicable requirements.
The broader lesson is simple: organized billing records matter when payment is challenged.
Practices Should Not Treat Every Out-of-Network Claim the Same Way
Out-of-network status can mean different things in different circumstances.
For example, a provider may intentionally operate outside a patient’s insurance network. In another situation, a patient may receive care from an out-of-network provider unexpectedly while receiving services at an in-network facility.
The No Surprises Act applies to specific situations, not every out-of-network encounter.
This means billing teams need to understand the circumstances surrounding the service rather than applying a blanket rule to every claim.
What Is the Good Faith Estimate Requirement?
The No Surprises Act also includes requirements related to good faith estimates for certain uninsured and self-pay individuals.
A good faith estimate provides information about expected charges for scheduled services.
The purpose is to give eligible patients greater financial transparency before receiving care.
Practices should understand when the requirement applies and establish an appropriate workflow for preparing and delivering estimates.
It is also important to recognize that a good faith estimate is different from an insurance benefit verification or a guaranteed final patient bill.
Healthcare charges can involve multiple providers and services, and actual costs can vary depending on the circumstances.
Why Billing Teams Need Strong Internal Processes
The No Surprises Act is not something that should exist only as a legal document in a practice’s compliance files.
Its requirements can affect day-to-day operations.
Scheduling staff may need to identify whether a patient is uninsured or self-pay.
Front-office personnel may need to collect accurate information.
Billing teams may need to identify potentially applicable protections.
Administrative staff may need to maintain documentation.
Leadership may need to review how disputes and patient financial communications are handled.
This makes the issue cross-functional.
Common Mistakes Practices Should Avoid
Assuming Every Out-of-Network Balance Is Collectible From the Patient
The existence of a patient balance does not automatically mean the practice can bill the patient for the entire difference between its charge and the insurer’s payment.
The circumstances of the service and applicable protections must be considered.
Treating Documentation as an Afterthought
If a payment dispute develops months after a service, missing documentation can make it much harder to reconstruct what happened.
Ignoring Deadlines
Dispute resolution processes can involve specific timeframes.
Waiting too long to investigate a payment issue can limit the practice’s options.
Failing to Track Payer Communications
Verbal conversations, written correspondence, claim responses, and other communications can become important when reconstructing the history of a disputed claim.
Assuming One Process Fits Every Payer
Healthcare practices work with different insurance plans and may encounter different contractual and regulatory requirements.
A standardized internal process should still leave room for payer-specific circumstances.
How the Issue Can Affect Smaller Medical Practices
Large health systems may have dedicated teams handling reimbursement disputes.
Smaller practices may not have that luxury.
A physician-owned practice may rely on a small administrative team to manage billing, claims, patient statements, insurance communications, and other responsibilities simultaneously.
That can make complex payment disputes particularly time-consuming.
A practice may have a legitimate financial issue but lack the staff capacity to investigate it thoroughly.
This is one reason organized billing workflows and professional billing support can be valuable for smaller healthcare organizations.
What Medical Practices Can Do Now
Practices do not need to wait for a dispute to occur before improving their processes.
Review Out-of-Network Workflows
Understand how the practice identifies out-of-network situations and how applicable patient protections are incorporated into the billing process.
Strengthen Documentation
Make sure claim-related information can be retrieved efficiently when questions arise.
Train Administrative Staff
Staff should understand when to escalate unusual billing situations instead of making assumptions about patient responsibility.
Monitor Payment Disputes
Track recurring payer issues to determine whether certain types of claims or services generate disproportionate administrative work.
Keep Up With Regulatory Developments
The No Surprises Act continues to be an area of policy and operational attention.
Recent developments demonstrate that providers and insurers are still navigating how the dispute resolution system should function.
Practices should therefore avoid relying indefinitely on outdated procedures.
Why This Matters Beyond Compliance
It can be tempting to view the No Surprises Act exclusively as a compliance issue.
For medical practices, its impact can extend further.
Out-of-network situations, payment disputes, patient statements, documentation, and reimbursement processes are all connected to the financial side of healthcare operations.
A practice that understands these relationships can respond more effectively when unusual payment situations arise.
The objective is not simply to avoid regulatory problems.
It is also to create a billing operation that can accurately document services, understand payment outcomes, communicate appropriately with patients, and respond when a payer dispute develops.
How Billing Nerds Can Help
Billing Nerds helps healthcare practices manage the administrative and financial side of their operations through services including Medical Billing, Documentation Review, Patient Statements, Insurance Credentialing, Business Consulting, and Strategy & Marketing.
Complex payer requirements can create additional administrative pressure for practices that are already managing busy clinical operations.
A structured billing process can help practices maintain better documentation, monitor claims, organize payment information, and identify situations that may require additional review.
For practices dealing with complicated insurance payment issues, having knowledgeable billing support can also reduce the burden on clinical and administrative teams.
Looking Ahead
The No Surprises Act will remain an important part of the healthcare billing landscape.
At the same time, the ongoing debate surrounding federal payment disputes demonstrates that the relationship between providers and payers continues to evolve.
Medical practices should pay attention not only to whether a claim is paid, but also to the circumstances surrounding the payment, the patient’s protections, and the documentation supporting the transaction.
For billing teams, preparation starts with accurate information and consistent processes.
When a payment dispute arises, the practice should be able to answer basic questions quickly:
What service was provided?
What did the payer pay?
Why was that amount paid?
What documentation supports the claim?
What protections or dispute procedures apply?
Who is responsible for the next step?
Having those answers readily available can make complicated billing situations easier to manage.
Author: Rhonda Scantlebury