Health system’s forward-thinking approach to arbitration under the No Surprises Act leads to positive outcomes
Nutex Health, based in Houston, accomplished an exceptional success rate in independent dispute resolution in the fourth quarter by employing a third-party vendor in July to retrieve out-of-network claims under the No Surprises Act.
The network of microhospitals, led by physicians, entered into a contract with an undisclosed entity to aid in the retrieval of specific out-of-network claims during the arbitration process. This arrangement was detailed in a filing with the SEC on November 7. Nutex currently directs 60% to 70% of billable visits towards arbitration each month and is starting to observe the financial implications of this approach.
“Our proactive stance on arbitration within the framework of the No Surprises Act has generated favorable outcomes thus far,” expressed Nutex Chair and CEO Tom Vo, MD, in a news release on February 5. “We have successfully secured rightful reimbursements for our facilities and healthcare practitioners while maintaining our commitment to delivering high-quality and accessible healthcare services to our communities.”
Despite the positive results obtained, Nutex acknowledged the uncertainty regarding the consistency of arbitration successes and claim recoveries in the future. Additionally, potential adjustments to the federal Independent Dispute Resolution (IDR) process may lead to reductions in the amounts of claims recovered. Nevertheless, Dr. Vo expressed confidence in the establishment of strong foundations in 2024 that position Nutex Health favorably for further accomplishments in the upcoming year.
Nutex’s utilization of a strategic arbitration approach under the No Surprises Act has proven to be successful, with the network achieving over an 80% success rate in independent dispute resolution in the last quarter. By partnering with an external vendor, Nutex has effectively retrieved out-of-network claims in accordance with the Act.
Rather than leaving to chance the recovery of out-of-network claims, Nutex has actively engaged in arbitration, submitting a substantial portion of their billable visits monthly. This shift in strategy has begun to show positive financial outcomes for the organization.
The foresighted arbitration approach adopted by Nutex has not only led to favorable financial results but has also allowed the network to ensure fair compensation for its facilities and providers while continuing to offer superior and easily accessible healthcare services to the communities it serves.
Unpredictability remains concerning future arbitration outcomes and claim recoveries for Nutex, as unforeseen revisions to the federal IDR process could impact the recovery of claim amounts moving forward. Nonetheless, the solid groundwork laid by Nutex in 2024 has positioned the organization strongly for continued success in the coming year.