Emergency Physician Payment After the No Surprises Act: What the EDPMA Data Shows

What did EDPMA report about emergency physician payment?

EDPMA reports that average commercial cash per visit fell from $421.51 before the No Surprises Act to $396.10 after the Act, before IDR results were added. When the association counted every incremental IDR award as if it had been paid, the figure rose to $417.52. That is still $3.99 below the nominal pre-NSA level. EDPMA's inflation-adjusted benchmark is $490.93, making the reported post-IDR amount 15.0% lower.

The association's companion analysis of Level 4 emergency visits, CPT 99284, covered 873,900 commercial visits across 47 states. It reports that the average initial out-of-network payment fell from a $567.26 pre-NSA in-network baseline to $285.21 after the law, a 49.7% reduction. The average Level 4 IDR award was $649.06, compared with EDPMA's inflation-adjusted pre-NSA benchmark of $660.68.

Why does cash per visit differ from IDR award data?

Public-use files describe disputes that entered federal IDR. They do not, by themselves, show the full commercial payment stream for a practice. EDPMA's cash-per-visit analysis combines in-network and out-of-network emergency physician payments and weights annual results by visit volume. It compares 2019-2021 with 2022-2025, then adds the reported incremental effect of IDR awards.

The denominator matters. EDPMA reports 6,170,300 out-of-network visits from 2022 through 2025, but only 1,578,900, or 26%, were submitted to IDR. That means an award-focused analysis omits the 74% of reported out-of-network visits that did not enter IDR, including claims a practice may have declined to pursue because of cost, capacity, eligibility, or expected value.

Awards also are not the same as collected cash. EDPMA counted unpaid awards as if paid in the $417.52 post-IDR figure. The association reports that $78.3 million remained unpaid to survey respondents as of August 2026, including $22.2 million outstanding for more than one year and $5.4 million for more than three years.

What are the limits of the EDPMA findings?

The figures come from an association survey using member-supplied data. EDPMA says its members collectively serve about 60% of United States emergency department visits, but the two-page reports do not identify the number of responding organizations, payer mix by respondent, geographic weighting, or a public claim-level file that would permit independent replication.

The analysis also excludes IDR fees and internal administrative costs. Its inflation benchmark applies BLS medical-care price data through 2025 to a 2019 base. Those choices are disclosed, but different baselines or inflation measures could change the comparison.

This survey does not independently prove that federal IDR has no effect on premiums or establish national causation. Premiums reflect many variables beyond emergency physician reimbursement. The data instead test a narrower proposition: whether reported payment to participating emergency practices rose above their own pre-NSA benchmark after initial payments and IDR awards were considered.

GAO's 2026 report found relatively unchanged trends in in-network emergency medicine prices around the law's implementation. That in-network claims analysis is different from EDPMA's combined in-network and out-of-network cash-per-visit measure, which also adds reported IDR awards. The two studies should not be treated as measuring the same denominator.

Halkovich Law's commentary

EDPMA's most important contribution is not a single percentage. It is the decision to follow the payment sequence: pre-NSA reimbursement, the plan's initial out-of-network payment, the claims that reach IDR, the award, and whether the award is actually paid.

That sequence exposes the weakness in using provider win rates or award multiples as a complete measure of cost. A provider can prevail frequently in the subset of claims selected for IDR while the larger portfolio remains below its historical payment level. An award can be reported in federal data while the money remains outstanding. And an apparently large award can still fail to offset a sharply reduced initial payment, fees, delay, and the claims that were never disputed.

The EDPMA survey does not end the national cost debate. It does, however, make a serious case that policymakers should require total-payment evidence before describing emergency medicine IDR as a windfall. Any responsible analysis should state the initial payment, total claim universe, IDR submission rate, paid versus unpaid awards, fees, network mix, and inflation method.

For providers, the operational lesson is equally direct: a favorable determination is not the end of revenue recovery. The portfolio must be tracked through actual receipt, and recurring underpayment outside IDR should be measured alongside successful awards.

What should provider groups track now?

1. Establish a payer-specific baseline. Measure pre- and post-NSA cash per visit, allowed amount, network status, and service mix rather than relying only on award reports.
2. Separate initial payment from final recovery. Record the first payment, negotiation result, IDR award, payment received, and any remaining balance for each claim.
3. Measure the claims that never reach IDR. Capture eligibility, filing cost, resource limits, batching obstacles, and other reasons an underpaid claim was not pursued.
4. Age unpaid awards. Track the statutory payment deadline, days outstanding, payer communications, interest where applicable, and escalation history.
5. Include the cost of recovery. Account for administrative fees, entity fees, outside expense, internal labor, and the time value of delayed payment.
6. Preserve an auditable dataset. Maintain the EOB, claim record, open-negotiation notice, offers, IDR submission, determination, remittance, and bank-receipt evidence in one matter file.

Frequently asked questions

Sources and scope

This article is Halkovich Law's original provider-side commentary on EDPMA's November 9, 2026 release and its two companion reports. EDPMA is a provider trade association, and its results are presented as the association's survey findings rather than independent federal conclusions. Halkovich Law also reviewed the CMS federal IDR reporting page and GAO's February 2026 report for context.

This page provides general information, not legal advice about any specific claim, payer, dispute, or portfolio. Results depend on the governing law, plan type, network status, eligibility, deadlines, documentation, payer conduct, and claim-specific facts.