What Clinicians Should Know About the No Surprises Act
Patients do not want surprise bills, and neither do practices. A well-prepared organization protects trust, reduces administrative headaches, and avoids preventable compliance problems. That is why the right preparation is not just a legal safeguard, it is a business and patient-care strategy. Most importantly, we help clinicians avoid the kinds of surprises that create patient frustration, compliance risk, and revenue disruption. Our goal is to make your process predictable, defensible, and patient-friendly, so your team can focus on care instead of cleanup.
7/31/20263 min read
The No Surprises Act is not a failure
Critics of the No Surprises Act focus heavily on arbitration volume and provider win rates, but that is only part of the picture. The law’s central purpose was to protect patients from surprise medical bills, and the evidence shows it has done that by reducing out-of-pocket spending for some privately insured adults and removing patients from the middle of payment disputes (Liu et al., 2025; CMS, 2025). The more accurate conclusion is not that the law failed, but that its dispute-resolution system needs refinement (ASPE, 2024; AMA, 2025).
Patient protection came first
The strongest defense of the law is simple: patients are no longer being hit with the full force of surprise billing in the way they were before the NSA. Research published in 2025 found that out-of-pocket spending significantly decreased for adults with direct-purchase private insurance who gained surprise billing protections after implementation of the NSA (Liu et al., 2025). CMS’s consumer-facing guidance also makes clear that the law was designed to prohibit balance billing and limit consumer cost sharing, which remains a major consumer protection win (CMS, 2025). In other words, even if implementation has been messy, the policy’s core patient shield is working.
Disputes do not equal failure
The article treats the number of arbitration cases as proof the system is broken, but high use of a dispute process can also mean the process is serving a real role in a fragmented market. Recent CMS-linked reporting shows that providers and facilities initiated 99.9 percent of disputes in the first half of 2025, which suggests the volume problem is being driven by provider behavior more than patient harm (Georgetown CHIR, 2026). That same pattern does not automatically mean the whole model should be replaced; it means incentives need tighter guardrails (CMS, 2025). The issue is less “arbitration should not exist” and more “arbitration should not be easy to game.”
Spending effects are mixed
The article assumes arbitration is pushing overall healthcare costs higher, but the evidence is more mixed than that. A 2025 study found meaningful declines in out-of-pocket spending, while premium spending did not change in a measurable way after the NSA in that analysis (Liu et al., 2025). That does not prove the law lowers every kind of healthcare cost, but it does undercut the claim that the law is clearly inflating costs across the board. The Congressional Budget Office has also continued to frame the NSA’s effects as an area needing more research rather than a settled policy failure (CBO, 2026).
Better reform path
A more balanced response is to improve the dispute-resolution rules rather than abandon them. The American Medical Association has supported bipartisan efforts to address shortcomings in the IDR process and close enforcement gaps, which shows that even critics of current implementation are not calling for repeal (AMA, 2025). Other policy groups have argued for stronger reliance on median in-network amounts, better screening of filings, and tighter portal rules to reduce abuse without undermining patient protections (Third Way, 2026). That approach preserves the law’s biggest success while fixing the parts most likely to create waste.
A stronger conclusion
The better case is that the No Surprises Act is a patient-protection law with an imperfect payment backstop, not a failed experiment. It has reduced surprise billing exposure, lowered out-of-pocket spending for some patients, and shifted the debate toward how to improve arbitration rather than whether patients should be protected at all (Liu et al., 2025; CMS, 2025). If lawmakers want to reduce waste, they should target gaming and enforcement gaps, not discard the structure that keeps patients out of billing disputes (AMA, 2025; ASPE, 2024).
How clinicians can prepare
Clinicians and practice leaders should prepare for the No Surprises Act by tightening the systems that support billing, scheduling, eligibility checks, and patient communication. That means making sure good-faith estimates are issued when required, out-of-network scenarios are identified early, documentation supports billing decisions, and staff know how to explain patient cost-sharing clearly. Practices should also review their workflows for consent, referral pathways, and dispute documentation so they are not caught off guard when a claim is challenged.
The biggest mistake is assuming the No Surprises Act only affects billing teams. In reality, it touches front-desk scripting, clinical scheduling, insurance verification, coding, and the handoff between clinical and administrative staff. When those pieces are not aligned, surprises happen — for the practice and for the patient.
How our consulting group helps
Our consulting group helps practices build clear, compliant workflows so they are not left reacting after the fact. We review your processes, identify risk points, and help your team create practical systems for estimating, documenting, communicating, and billing in ways that reduce surprise exposure. We also help staff understand what to say, what to document, and how to handle common No Surprises Act situations before they turn into problems.
Most importantly, we help clinicians avoid the kinds of surprises that create patient frustration, compliance risk, and revenue disruption. Our goal is to make your process predictable, defensible, and patient-friendly, so your team can focus on care instead of cleanup.
Why this matters
Patients do not want surprise bills, and neither do practices. A well-prepared organization protects trust, reduces administrative headaches, and avoids preventable compliance problems. That is why the right preparation is not just a legal safeguard — it is a business and patient-care strategy.