The bill represents more than a commitment to research. It creates a pathway for federal health agencies to evaluate current evidence, improve prevention strategies, and support future recommendations that can help patients receive care sooner. Backed by radiologists and leading healthcare organizations, the legislation reflects a growing consensus that meaningful progress requires both scientific innovation and decisive action.

The opportunity before us is clear. By investing in women focused lung cancer research today, policymakers can help unlock discoveries that improve screening, expand treatment options, and deliver better outcomes for generations to come. As this legislation moves forward, it offers a powerful reminder that when research is prioritized, lives can be changed, and futures can be rewritten.

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Across the country, policy is being created at the state level, but each state has different strategies. For example, Utah has embraced a more innovation-focused approach, creating opportunities for organizations to test emerging technologies through regulatory sandboxes. Meanwhile, states like Nevada and Illinois have placed greater emphasis on licensure, accountability, and the responsibilities clinicians retain when AI tools are involved in care delivery. The growing divergence in state policies sends a clear message: healthcare organizations cannot afford to wait for a single national standard before establishing their own frameworks for responsible AI use.

Perhaps the most pressing concern is that AI adoption appears to be outpacing AI governance. While clinicians are using these technologies more frequently than ever, a recent Wolters Kluwer report found that only 27% of doctors and nurses understand how their organization is addressing AI governance. That gap represents more than a communication challenge. As states continue advancing their own AI policies and regulators increase scrutiny of AI developers, including recent multi-state investigations into OpenAI, expectations around transparency and accountability are only growing. Healthcare organizations will need to establish clear oversight, define accountability, and build trust around how AI tools are evaluated, monitored, and deployed. As regulations continue to evolve, organizations that invest in governance today will be better positioned to unlock AI’s potential while maintaining confidence among clinicians, patients, and regulators alike.

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• Sign up to be an Advocate, text ZOTEC to 50457, or click here.

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That’s why a growing coalition of lawmakers is pushing for meaningful reform. Bipartisan legislation including H.R. 6160, the Strengthening Medicare for Patients and Providers Act, H.R. 8163, the Provider Reimbursement Stability Act, and H.R. 7520, the Efficiency Adjustment Delay Act, seeks to modernize Medicare reimbursement and create a payment framework that better reflects the real-world cost of delivering care. These proposals do more than address individual pain points; they represent a broader commitment to building a more sustainable future for physicians and the patients who rely on them.

The momentum behind these efforts is impossible to ignore. Additional legislation such as H.R. 7863, the Promoting Fairness for Medicare Providers Act, reinforces a growing consensus that Medicare payment policy must evolve to preserve patient access, strengthen community-based care, and support the clinicians driving healthcare forward. For physician groups and healthcare leaders, this moment represents more than legislative activity; it is an opportunity to help shape a Medicare system that rewards innovation, promotes stability, and ensures high-quality care remains accessible for years to come.

To learn more about these proposals and what they could mean for physicians, tune in to the latest episode of Zotec Answers. Then take action through Zotec’s advocacy campaign and help support Medicare payment reforms that strengthen physician practices and protect patient access to care. On the go? Simply text ZPPAY to 50457 to take action.

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• Sign up to be an Advocate, text ZOTEC to 50457, or click here.

• Follow us on LinkedIn and X for more updates.

• Check back Tuesdays and Thursdays for A to ZPAC blog posts.

• Review our Monthly Wrap Up Newsletters

  

A new analysis from RadBoard.io confirms what many radiologists already know: the workforce shortage is not affecting every community equally. States like Nebraska and Minnesota continue to struggle with radiology vacancies that remain open for months, leaving physicians stretched thin and patients waiting longer for care. As imaging demand grows, these workforce gaps are becoming harder to ignore.

The report found that higher pay alone is not solving the problem. Many hard to fill positions remain open because of location, call responsibilities, and workflow challenges that make recruitment difficult. For radiologists, that means more pressure on already busy schedules and fewer opportunities to focus on the complex clinical work that matters most.

The good news is that technology is creating new ways to support physicians and expand access to care. With AI expected to appear in nearly 30% of radiology job postings by the end of the year, there is growing momentum behind solutions that help radiologists work more efficiently and reach underserved communities. Supporting this legislation will help accelerate that progress and ensure physicians have the tools they need to deliver timely, high-quality care wherever patients need it most.

The impact extends beyond paperwork and compliance concerns. When QPA requirements are not followed or payments are delayed after a final IDR decision, physicians and healthcare organizations are left navigating unnecessary obstacles that divert resources away from patient care. These delays can strain practice operations, disrupt cash flow, and make it more difficult for providers to invest in the staff, technology, and services their communities rely on.

Fortunately, momentum is built to address these challenges. Recent reforms to the IDR process, including a centralized disputes portal, streamlined communications, and lower administrative fees, represent meaningful steps toward greater transparency and accountability. By continuing to strengthen enforcement and improve payer compliance, policymakers have an opportunity to ensure the No Surprises Act delivers on its promise of a fair, efficient dispute resolution system that supports physicians and the patients they serve.

Now is the time to keep the momentum moving forward. Physicians see firsthand how delayed payments and payer noncompliance impact healthcare delivery, making their voices essential in this conversation. We encourage you to contact your members of Congress and support policies that strengthen accountability, improve compliance, and ensure physicians are paid fairly and promptly. Take action today through our advocacy center and help advance meaningful reform

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Artificial intelligence (AI) is quickly moving from pilot programs to everyday healthcare operations, creating new opportunities to improve efficiency, support clinical decision-making, and enhance patient care. But as adoption accelerates, healthcare organizations are also facing important questions around governance, transparency, accountability, and patient trust. And just this week, the White House released its Advanced Artificial Intelligence Innovation and Security Executive Order, highlighting the growing national focus on AI oversight and responsible action. To help address these challenges, the Coalition for Health AI (CHAI) has released a new series of playbooks designed to guide responsible AI implementation across healthcare settings.

The playbooks outline eight key pillars of AI governance, including risk management, data stewardship, workforce education, and third-party oversight. They also provide practical recommendations such as establishing formal AI policies, clearly defining how AI tools are used, and assigning designated leadership responsibility for oversight and accountability. By translating broad principles into actionable guidance, the framework gives healthcare organizations a roadmap for moving beyond experimentation and toward sustainable AI adoption.

As healthcare leaders evaluate how AI fits into their organizations, the focus is increasingly shifting from whether to adopt these technologies to how to implement them responsibly. Recent actions from both industry leaders and policymakers reflect a growing recognition that innovation must be accompanied by clear governance and accountability. Organizations that establish strong governance frameworks today will be better positioned to build trust with patients, clinicians, and regulators while maximizing the long-term benefits of AI innovation

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After years of instability and temporary Medicare payment fixes, Congress is beginning to take a more serious look at physician payment reform. With the Centers for Medicare and Medicaid Services (CMS) expected to release the 2027 Medicare Physician Fee Schedule (MPFS) proposed rule in July, lawmakers are beginning to examine several bipartisan proposals aimed at addressing the financial uncertainty that continues to pressure physician practices and threaten patient access to care.

Together, these bills reflect growing recognition that the current system is becoming increasingly difficult to sustain. First, the Strengthening Medicare for Patients and Providers Act (H.R. 6160) would tie physician payment updates to inflation through the Medicare Economic Index (MEI). The Provider Reimbursement Stability Act (H.R. 8163) focuses on reducing sudden reimbursement swings and improving payment predictability, while the Efficiency Adjustment Delay Act (H.R. 7520) would delay CMS’s planned efficiency adjustment policy to allow more time for evaluation and physician input. While each bill addresses a different challenge within the MPFS, together they represent a broader push toward stability, transparency, and long-term sustainability.

Momentum is already beginning to build. Most notably, H.R. 8163 recently advanced unanimously out of the House Ways and Means Committee and now heads to the full House for consideration, signaling growing bipartisan recognition that physician payment stability can no longer be ignored. As the July proposed rule approaches, physician voices will remain critical in shaping the future of Medicare reimbursement and protecting patient access to care. Now is the time to stay informed, stay engaged, and be ready to take action. Sign up to become a ZPAC advocate so you can receive updates on the proposed rule and opportunities to make your voice heard when it matters most.

After three years of anticipation and mounting administrative strain, the Tri-Departments have finalized the No Surprises Act (NSA) Independent Dispute Resolution (IDR) Operations Rule. The final rule includes several important updates intended to improve communication, reduce ineligible disputes, and make the federal IDR process more efficient, including:

• Reducing the administrative fee from $115 to $15 per party per dispute, representing an 85%+ reduction in fees.

• Moving open negotiation through the Federal IDR portal, with expanded notice requirements and a required response notice within the first 15 business days.

• Requiring plans and issuers to register in the Federal IDR portal.

• Clarifying and expanding batching rules, while reducing the cooling-off period for batched disputes from 90 business days to 30 business days.

• Requiring plans and issuers to use CARCs and RARCs on remittance advice to communicate NSA-related claim information.

To learn more, read our full A to ZPAC blog post.

H.R. 8163: Congress Takes a Step Toward Medicare Payment Stability

Medicare physician payment has declined 33% since 2001.
Now, Congress may finally be preparing to respond.

For the first time in years, lawmakers are advancing legislation that could help stabilize Medicare physician payment and protect patient access to care. Last week, the House Ways and Means Committee unanimously advanced the bipartisan Provider Reimbursement Stability Act of 2026 (H.R. 8163), a major step toward modernizing Medicare physician payment. Supported by multiple radiology societies and physician advocates, the bill would help reduce damaging reimbursement volatility and create greater stability for physicians already operating under mounting financial pressure.

For independent practices and rural communities especially, that stability could make all the difference.

Why H.R. 8163 Matters

• Helps reduce harmful Medicare payment instability

• Supports independent physician practices

• Protects patient access to care

• Modernizes outdated reimbursement policies

• Brings greater predictability to physician reimbursement

The need for action has never been more urgent. Physicians are being asked to do more with less, while the cost of delivering care continues to rise year after year. Patients are already seeing the impact through reduced access to care, practice consolidation, and fewer physicians able to accept Medicare patients. H.R. 8163 would help bring much-needed stability to physician reimbursement and better align Medicare policy with the real cost of delivering care.

This legislation is not just about reimbursement. It is about protecting access to care and preserving the future of independent medicine. Chairman Jason Smith noted that the bill would help physicians keep their doors open while holding Washington accountable for unreliable payment calculations that have created years of uncertainty.

Now, the bill advances to the full House, and continued advocacy will be critical.

If Congress fails to act, more physicians will be forced to make difficult decisions about whether they can continue serving Medicare patients, and patients will ultimately pay the price through reduced access to care. Congress cannot afford to wait. Now is the time to speak up and support H.R. 8163.

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has announced a one-year extension for compliance with its digital accessibility requirements under Section 504 of the Rehabilitation Act. The updated deadline moves compliance to May 11, 2027, for organizations with 15 or more employees and May 10, 2028, for organizations with fewer than 15 employees. Healthcare organizations now have more time to prepare, but the expectation to comply is not going away.

The rule represents a significant shift for healthcare organizations receiving federal financial assistance, including physicians participating in Medicare, Medicaid, CHIP, and other federally supported programs. For the first time, healthcare entities are being required to meet formal accessibility standards for websites, mobile applications, and kiosks under a broader legal framework tied to digital access. As patient engagement continues shifting toward digital platforms, the rule places greater scrutiny on how healthcare organizations design and deliver online experiences for patients. HHS has made clear that the growing reliance on digital healthcare tools requires equal accessibility for individuals with disabilities, placing increased attention on how patients engage with healthcare services online.

This extension also comes during broader conversations about governance and accountability in healthcare technology. As artificial intelligence (AI), digital patient engagement tools, and connected healthcare platforms expand across healthcare, regulators are paying closer attention to how these technologies affect patient access and experience. Digital accessibility is becoming part of a larger expectation that healthcare technology be usable, equitable, and operationally accountable from the start. This extended compliance timeline may also signal where broader healthcare regulation and digital oversight are headed next.

For more insights on the policy and technology trends shaping healthcare, explore the latest episodes of the Zotec Answers podcast.

Prior authorization continues to be one of the most significant administrative pressures facing physicians, contributing to delays in care, workflow disruption, and growing operational strain across healthcare. Recent reforms from the Centers for Medicare and Medicaid Services (CMS), combined with new voluntary commitments from health plans, signal that pressure is mounting to simplify and modernize the process. While many physicians are already familiar with the growing scrutiny around denial rates and transparency requirements, the next phase of reform is increasingly focused on reducing administrative burden and improving the speed and consistency of prior authorization decisions.

CMS’s 2024 prior authorization rule introduced new requirements related to electronic prior authorization, approval timelines, and public reporting for certain health plans, with additional proposals aimed at expanding similar standards to medications covered under medical benefits. At the same time, health plans have announced voluntary efforts to standardize electronic submissions, improve communication around determinations, and streamline reviews. In April 2026, AHIP and the Blue Cross Blue Shield Association announced that 49 health plans committed to adopting more standardized prior authorization submission practices across a range of medical services, extending some reforms beyond CMS-regulated plans.

Attention is also shifting toward reducing the number of services that require prior authorization altogether. CMS recently stated that leading health plans eliminated 11% of prior authorizations for certain medical services, representing an estimated 6.5 million fewer authorization requirements for patients, while some national insurers have announced plans to scale back requirements even further. Many of these reforms will take time to fully implement, but together they reflect increasing industry and regulatory momentum toward reducing friction in the prior authorization process. As more data becomes available, physicians and healthcare leaders will be watching closely to see whether these changes translate into measurable improvements for patient access and practice operations.

Physicians across the country are continuing to call on Congress to step in and enforce the No Surprises Act (NSA), because the current system is not working. Organizations, including the American College of Radiology, the American Society of Neuroradiology, and all 50 state medical societies, are united in urging the passage of the No Surprises Act Enforcement Act (H.R. 4710, S. 2420). The NSA was designed to protect patients and create a fair process for resolving payment disputes, but that promise is being undermined. Physicians are winning independent dispute resolution cases and still not getting paid, putting both practices and patient access at risk.

This is not a gray area; it is a failure of accountability that demands action now. Physicians continue to report missed payment deadlines well beyond the required 30-day window, along with inconsistent eligibility determinations and tactics that delay or avoid reimbursement. Without enforcement, even the strongest policies lose their impact. The NSA Enforcement Act would close these gaps by increasing penalties for noncompliance and strengthening transparency, ensuring the system works as intended for physicians and the patients who depend on them.

Our team is boots on the ground, meeting directly with lawmakers to drive support and keep this issue front and center. As part of that effort, we are launching a new Zotec Answers segment, “The DC Download with Mark Isenberg”, sharing firsthand insights from conversations on Capitol Hill and what comes next.

But meaningful change requires more than conversations in Washington, it requires your voice. Take 10 seconds today to contact your lawmakers and urge them to support the NSA Enforcement Act, because when physicians speak up together, lawmakers listen and action follows.

Watch today!

Artificial intelligence (AI) has not become compassionate, but its rapid progress has made one thing clear: medicine has drifted from the bedside. Physicians often work under constant time pressure and interruption, pulling them away from direct patient care. Much of that time is spent on administrative work and other necessary tasks that compete with time at the bedside. Reducing that burden creates the time and space for physicians to be fully present with their patients.

This is where AI can support, not replace, clinical care. Documentation, coding, triage, and pattern recognition can be augmented with AI tools, allowing physicians to focus their attention where it is most needed. Under time pressure, when reasoning is most vulnerable, AI can help maintain diagnostic accuracy. When cognitive load is reduced, physicians have greater capacity for the unpredictable and deeply human moments in care. What remains essential cannot be delegated: the examination, the reassurance of a steady presence, and the willingness to listen and stay with patients through uncertainty.

The impact of these tools will depend on how they are used in practice. Physicians and the broader care team must remain accountable for guiding their AI use and upholding their responsibility to deliver high quality care. By taking on administrative work, AI can help bring physicians back to their patients. The bedside has always been the foundation of care, and with thoughtful implementation, these tools can help restore time, attention, and focus to where they matter most.

Healthcare is entering a new phase where adopting technology is no longer the differentiator, making it work at scale is. For physicians, this shift shows up in every day in missed follow-ups, delayed diagnoses, and growing pressure to do more with less. In support of this shift, the American Hospital Association’s (AHA) new three-year initiative signals meaningful progress in helping hospitals and health systems turn technology investments into measurable impacts. Through the West Health Accelerator, organizations gain access to shared resources and peer-driven insights to scale tools like EHR optimization, telehealth, and artificial intelligence (AI) in ways that support clinical care.

Yet even as these capabilities expand, persistent gaps in access to care remain highly visible in the clinical workflow. Missed breast imaging appointments, the most common no-shows in radiology, are often driven by factors like forgetfulness, financial strain, and transportation issues. For physicians, this often means seeing patients later in the disease process, when treatment becomes more complex and outcomes less certain. With nearly a third of patients never rescheduling, these gaps place added strain on clinicians while also disrupting continuity of care and practice financial performance.

This is where the connection between scaled technology and patient access becomes critical. When implemented with intention, tools like automated reminders, streamlined scheduling, and better patient engagement platforms can reduce no-shows and help ensure patients receive care when it matters most. For physicians, that translates to more timely interventions, more effective care plans, and fewer preventable complications. As the industry moves forward, the urgency is clear: technology must do more than exist, it must actively support clinicians in closing gaps in care and improving outcomes for the patients who depend on them.

Medicare payment cuts are no longer a slow-moving policy issue; they are actively reshaping the business of healthcare. Since 2001, physician payments have declined 33% when adjusted for inflation, even as the cost of delivering care continues to rise. That widening gap is playing out in real time, with fewer physicians accepting Medicare, increased consolidation, and growing access challenges, especially in rural communities. Importantly, it is not just the cuts themselves creating pressure; it is the unpredictability behind them that makes long-term planning increasingly difficult. When physicians cannot anticipate year-to-year payment changes, it becomes harder to invest in their practices, support their teams, and continue serving their communities.

At the legislative level, there are signs that policymakers are starting to respond. The Provider Reimbursement Stability Act (H.R. 8163) was reintroduced with bipartisan support to bring greater predictability to physician payments and reduce disruptive cuts. However, this effort represents just one part of a broader shift underway across healthcare policy. Enforcement questions around the No Surprises Act persist, payer behavior continues to evolve, and artificial intelligence (AI) is rapidly influencing both operational and policy expectations. These dynamics are reshaping the environment physicians and healthcare leaders are navigating every day, making it increasingly important to stay informed and engaged.

That is exactly where our monthly newsletter comes in. Each edition cuts through the noise to deliver clear, relevant insights into the policy changes, advocacy efforts, and industry trends that matter most. Our newsletter is designed to connect the dots, helping you quickly understand what is happening, what is coming next, and where to focus your attention.

Read our April newsletter to stay informed and ahead of what is shaping healthcare today.

Physicians are increasingly raising concerns about how health insurers are undermining the protections the No Surprises Act (NSA) was designed to establish. More than 100 specialty societies and state medical associations recently sent a unified message to federal agencies, warning that current payer practices are putting patients, physicians, and physician groups at risk. The NSA, originally passed in 2020, was intended to shield patients from unexpected medical bills and create a fair process for resolving payment disputes. Instead, growing evidence suggests that some insurers are exploiting gaps in the law to sidestep its intent. What was designed as a safeguard is now showing consistent signs of strain.

Across the industry, physicians are seeing consistent and troubling patterns that are reshaping how the law functions. Physicians describe insurers shifting costs back onto patients even after losing payment determinations, reopening closed cases based on questionable interpretations of recent federal guidelines, and labeling claims as ineligible for the independent dispute resolution (IDR) process without clear explanation. At the same time, many payers are failing to disclose how key payment benchmarks are calculated and delaying or withholding reimbursement after arbitration decisions. These tactics not only strain physician practices, but also erode trust in a system that was designed to bring stability. If this continues, the long-term impact will extend beyond practices to the patients and communities who rely on them.

This trajectory is unsustainable, and it demands action from the physician community. Advocacy plays a critical role in ensuring the law is enforced as intended and that bad behavior does not go unaddressed. Physicians can take immediate steps by urging lawmakers to support the No Surprises Act Enforcement Act (U.S. H.R. 4710, S. 2420), a measure aimed at strengthening oversight and accountability. It takes 10 seconds to send a message to Congress, but that message carries weight. Then, invite lawmakers into your practice to help them see the real-world impact these challenges create. When physicians speak up, it drives awareness, accountability, and meaningful change.

Commercial health insurers are deploying artificial intelligence (AI) to systematically downcode claims, automatically reducing Evaluation and Management (E/M) levels, and lowering the severity assigned to hospital stays to reduce reimbursement. Reports indicate that no physician reviews the underlying records, and that limited, or no clinical judgment, may be applied in certain cases. Recently, Maryland’s Insurance Administration ordered Cigna to cease its auto-downcoding policy and reprocess all affected claims citing concerns about insufficient clinical review, and a federal court ordered UnitedHealth to produce the source code behind its AI tool after reports that denial rates increased significantly following its rollout. This is not an anomaly, as lawsuits and regulatory actions against insurers for automatic downcoding have surged through 2025 and into 2026.

The financial toll is real and compounding. Denial rates have climbed from 30% of physicians reporting more than 10% of claims denied in 2022 to 41% in 2025. For independent and physician-owned practices already navigating workforce shortages and rising costs, each downcoded claim represents lost revenue that is difficult, if not impossible, to recover. Rural and safety-net practices may be disproportionately impacted, lacking the administrative capacity to catch what is often a single remark code buried in an explanation of benefits.

Insurers argue that physicians use AI to upcode, and in isolated cases, that’s true. But it does not justify a system where algorithms reduce reimbursement with limited clinical oversight, and the entire burden of appeal falls on already stretched practices. Recent survey data suggests that over 61% of physicians report that unregulated insurer AI is overriding sound medical judgment. States are beginning to act, and the legal environment is tightening. As scrutiny increases, practices that understand this landscape and build the operational capacity to respond will be far better positioned to protect revenue, sustain operations, and support patients’ access to care.

Recently, UnitedHealthcare announced a decision to eliminate prior authorization requirements for most procedures in rural areas. It is a notable step that signals some recognition of what physician practices have been navigating for years: prior authorization that slows care, stretches already limited staff, and adds friction to daily operations. In rural settings, where resources are often constrained, even a partial reduction in administrative burden can mean fewer delays, less time spent chasing approvals, and a clearer path to care for patients. At the same time, it raises a broader question: if these burdens warrant relief in rural communities, why do they persist so widely elsewhere?

Because when you look beyond this announcement, the broader data reinforces just how entrenched prior authorization remains. New CMS transparency requirements show that in 2024, the denial rate across Medicare Advantage and Medicaid Managed Care plans was 7.7%, yet only 11.5% of those denials are appealed. That gap is not simply a matter of choice. For many practices, pursuing appeals requires time, staffing, and resources they do not have, especially when weighed against other operational demands. And yet, when physicians do appeal, they win 80.7% of the time, exposing a disconnect between initial determinations and clinical appropriateness that continues to delay care and disrupt revenue.

Looking across the industry, the patterns become even more difficult to ignore. Despite differences in how frequently prior authorizations are required, UnitedHealthcare, Humana, and Elevance report nearly identical denial rates per enrollee, all falling between 12.6% and 12.8%. That consistency points to systemic issues. While targeted policy changes like this may offer relief in specific areas, they do little to change the broader reality physicians face. The data tells a more complete story: prior authorization remains deeply embedded, consistently applied, and frequently overturned, raising important questions about how these decisions are made and who they ultimately serve.

For many physicians and practice leaders, it can be easy to tune out the noise in Washington, D.C. Between rising costs, staffing shortages, and constant pressure from payers, the daily demands of running a practice leave little time to track political shifts. It can feel like the same conversations happen every year, but the reality is that decisions affecting your day-to-day are being made by lawmakers, fewer than 3% of whom have a background in healthcare. With so much turnover happening in Congress, that dynamic is only becoming more important. In fact, the changes underway in 2026 could directly shape the policies tied to your revenue, your operations, and your patients.

This year, a record number of House members are stepping away, with 56 retirements announced as of mid-April, the highest level since 1992. What stands out this year is the pattern: a significant share of departures are coming from the majority party, including experienced leaders who have helped shape healthcare policy. At the same time, more members are leaving earlier in their careers or choosing to pursue roles at the state and local level, signaling a shift in where they believe they can make the greatest impact.

Moments like this, with significant turnover in Congress, create real openings to shape what comes next, especially on issues like reimbursement, administrative burden, and patient access. Right now, that includes a growing problem many practices are already experiencing: insurers ignoring the No Surprises Act (NSA). Even after losing in the Independent Dispute Resolution (IDR) process, some insurers are delaying payments and facing no meaningful consequences, adding strain to practices and putting patient access at risk. The No Surprises Act Enforcement Act would give federal regulators the authority to enforce payment deadlines and hold insurers accountable, but it needs support to move forward.

As new and returning lawmakers define their priorities, this is a critical window to ensure they hear directly from physicians and practice leaders about what is and is not working. It may be tempting to tune this out, especially when the system feels frustrating or disconnected, but that is exactly what makes your voice so important right now. Urging lawmakers to cosponsor this legislation is a direct, meaningful way to help ensure the law works as intended. This is a moment to make your voice heard. Inaction has real consequences, but so does engagement, and your voice can help shape what comes next for your practice and your patients.

Take Action!

The No Surprises Act (NSA) was designed to protect patients from unexpected medical bills and create a fair, consistent process for resolving payment disputes between insurers and clinicians. While the law has largely succeeded in taking patients out of the middle, it has also exposed ongoing disagreements behind the scenes, particularly around the independent dispute resolution (IDR) process. Insurers and clinicians are continuing to clash over what constitutes fair reimbursement, with both sides raising concerns about how the system is being used and whether it is working as intended. But the debate over IDR is only part of the story.

Recently, scrutiny of the IDR process has increased, resulting in legal disputes and questions about how claims are submitted and adjudicated. At the same time, it has become clear that there is an enforcement issue when it comes to the NSA. Across the country, insurers are delaying payments, even after losing in the IDR process, missing required deadlines, and facing little to no consequences. For physician practices, that has created real strain, making it harder to maintain financial stability and continue delivering care. This gap between the law and reality is the real issue, and recent federal guidance falls short of fixing it.

The Departments’ (Departments of Labor, Health and Human Services, and Treasury) newly released FAQ Part 73 highlights continued efforts to refine the process, rather than address enforcement. But guidance alone does not solve the core issue. Without meaningful enforcement, the protections and structure established by the NSA cannot function as intended, which is why legislative action is needed. The No Surprises Act Enforcement Act (H.R. 4710/S. 2420) would give regulators the authority to enforce payment deadlines and hold insurers accountable when they fail to comply. If the goal is to protect patient access to care and ensure a fair system for all parties, the law must be enforced.

Now is the time to act. Urge your lawmakers to support H.R. 4710/S. 2420 and help ensure the No Surprises Act works the way it was intended.