What is ACEP's enforcement argument?
ACEP argues that Congress should examine insurer conduct that drives claims into federal IDR before treating dispute volume or provider success rates as proof that the process is broken. The organization is calling for stronger enforcement of plan obligations, review of repeated defaults and extreme offers, scrutiny of QPA calculations, and preservation of the arbitration framework.
A high dispute volume is not, by itself, proof that providers are abusing IDR. The more useful question is why the claim did not resolve before arbitration.
What conduct did ACEP highlight?
The ACEP-hosted publication reports figures from the coalition's analysis of 2025 CMS data: insurers allegedly failed to participate and lost by default on 24.5% of IDR line items, made offers of $1 or less on 8.2% of line items, and submitted nearly 40% of nondefault offers at or below the qualifying payment amount.
Those figures are the organizations' interpretation of the federal data. They do not establish the merits of every provider or insurer offer. They do, however, identify questions that cannot be answered by looking only at final awards: Did the plan engage? Was its offer meaningful? Was the QPA reliable? Could the claim reasonably have settled earlier?
Halkovich Law's perspective
Federal IDR should be evaluated as a sequence, not as a scoreboard. The sequence begins with the initial payment, continues through open negotiation and each party's IDR offer, and ends only when the determination is paid. Weak performance at any stage can increase filings and prolong recovery.
That is why enforcement must address both participation and payment. A plan that defaults, submits a nominal offer, or does not timely pay a binding determination creates different problems, but each one prevents the statutory process from functioning as intended.
Congress can examine true outliers without presuming that the QPA is the correct market value or that a provider win automatically proves overreach. Useful reform should make data more reliable, obligations enforceable, and responsibility visible at every stage.
How providers can document the full sequence
- Preserve the initial payment or denial and every QPA disclosure.
- Keep the open-negotiation notice, delivery proof, responses, and settlement communications.
- Record both IDR offers and whether either party failed to participate.
- Retain the determination, proof of receipt, statutory payment deadline, and payment records.
- Track recurring defaults, nominal offers, delayed awards, and unpaid determinations by payer and plan.
A complete timeline gives counsel and regulators facts about the source of the dispute rather than only its final result.
Frequently asked questions
What is ACEP asking Congress to do?
Why does plan participation matter?
Does the reported data prove every provider offer is reasonable?
What should providers retain?
Sources and scope
This article comments on ACEP's published advocacy position. The percentages are attributed to the organizations' analysis and have not been independently recalculated by Halkovich Law. This page is general information, not claim-specific legal advice or a prediction about congressional action.
Show what happened at every stage.
Halkovich Law can assess payer conduct, IDR submissions, unpaid determinations, and recurring reimbursement patterns.