What are the physician groups asking Congress to address?
The American College of Emergency Physicians, American College of Radiology, and American Society of Anesthesiologists are asking Congress to examine insurer defaults, nominal offers, QPA calculations, and enforcement before weakening federal IDR.
The organizations argue that provider win rates and award multiples cannot be evaluated in isolation. Their position is that insurer payment and participation behavior helps explain why disputes enter IDR and why providers prevail in many cases.
What figures did the organizations present?
According to the physician societies' analysis of 2025 CMS data, insurers failed to participate and lost by default on 24.5% of IDR line items. The organizations also report that insurer offers of $1 or less occurred on 8.2% of line items and that nearly 40% of nondefault insurer offers were at or below the qualifying payment amount.
Those figures do not prove that every provider offer is reasonable or that every award reflects the correct market value. They do show why a serious assessment of IDR cannot rely only on provider success rates or the distance between an award and the QPA. The comparison must also examine whether the plan participated, what it offered, how the QPA was calculated, and whether the initial payment created a realistic path to resolution.
Halkovich Law's perspective
A high provider win rate is not self-explanatory. It may reflect a strong provider submission, an inadequate plan offer, a default, a disputed QPA, or some combination of those factors. Aggregate percentages cannot tell decision-makers which explanation applies unless the underlying conduct is separated and measured.
Congress should distinguish true outlier behavior from structural problems in the process. That means examining both sides' offers, requiring reliable QPA calculations, identifying repeat defaults, enforcing payment and participation obligations, and preserving a neutral forum for disputes that do not resolve through initial payment or open negotiation.
Reform should improve accountability without turning the QPA into a presumptive answer or making a provider's access to IDR depend on accepting a payment that does not reflect the claim record.
What providers should document now
- Initial payments, remittance details, and the QPA disclosed for each eligible claim.
- Open-negotiation correspondence and whether the plan meaningfully responded.
- Each party's IDR offer, any default, and the certified entity's determination.
- Patterns of nominal offers, repeated defaults, delayed payments, or unpaid awards by payer and plan.
- Evidence supporting the provider's offer, including service complexity, training, acuity, market conditions, and prior contracting history where relevant.
That record can support an individual dispute while also showing whether a broader payer pattern should be escalated through legal, regulatory, or contracting channels.
Frequently asked questions
Which physician organizations sent the analysis to Congress?
What did the organizations report about insurer participation?
What action are the groups requesting?
What is the practical takeaway for providers?
Sources and scope
The percentages discussed above are attributed to the physician organizations' analysis and have not been independently recalculated by Halkovich Law. This article offers general provider-side commentary, not claim-specific legal advice or a prediction about congressional action.
Turn payment patterns into a usable record.
Halkovich Law can evaluate payer conduct, IDR documentation, unpaid determinations, and reimbursement issues that warrant escalation.