The Service Line

Reimbursement: The federal safe harbor for insurers’ 2021 payment-benchmark math ended September 30, and we found no replacement

Nobody has renewed it. The Departments of Labor, Health and Human Services, and the Treasury let insurers and arbitration parties keep using the 2021 method for the qualifying payment amount (QPA), the in-network benchmark behind every out-of-network emergency claim under the No Surprises Act, without enforcement risk. FAQ Part 73 carried that relief for services furnished February 1 through September 30, 2026, according to an International Foundation of Employee Benefit Plans summary (we could not extract the CMS PDF’s text). The Labor Department’s FAQ index lists a Part 74 as a wellness-program document, not a No Surprises Act extension, and the CMS reports page shows no October guidance. The agencies have said they will issue QPA guidance after the Fifth Circuit finishes the TMA III litigation, and the en banc court ruled August 11, so a successor document is the next thing to watch. Separately, CMS, Labor and Treasury met October 1 with all 17 certified arbitration entities, per a CMS news alert, on ineligible disputes, unclear determination rationales, and delayed or unpaid awards. The alert announced no fixes and no timeline, and said the federal portal becomes the “IDR Gateway” in late 2026. For emergency groups, the unpaid-after-award problem is the cash-conversion risk to price in. Confidence: High on the October 1 meeting and the Part 73 dates. Medium on “no successor yet,” because that rests on the absence of a posting on the pages we checked.

Enforcement: A $20 million urgent care settlement over upcoded visits, and the federal emergency E/M audits are still open

Heal 360 Urgent Care and Heal 360 Primary Care, two Plano, Texas clinics, and their owner physician agreed to pay $20 million to resolve False Claims Act allegations, the Justice Department announced October 7. The government alleged the clinics billed the federal COVID-19 Uninsured Program for higher-level evaluation and management visits (codes 99203, 99204, 99213 and 99214) when the service was a nasal swab collection that belonged under 99211, supported by template-generated charts, with the owner listed as rendering physician on most claims, between January 2021 and March 2022. The settlement resolves allegations only. It is urgent care, not an emergency department, but it is the template for how the government now argues visit-level inflation: the chart does not match the code. The Office of Inspector General’s emergency department E/M work plan project remains active with two audits underway, one announced June 2024, and an estimated finish in fiscal 2027, so groups with high shares of 99285 and 99291 should assume an audit lane exists. Confidence: High on the settlement terms and the audit status as posted. Low on any read-through to emergency physician billing.

Who’s Buying: No emergency or hospitalist staffing transaction surfaced this week

We searched for contract displacements, acquisitions and bankruptcies among emergency and hospitalist groups for the past seven days and found none dated October 2026. One search hit pointing to a recent emergency staffing firm event traced back to 2024 and 2025 reporting on NES Health, so we did not use it.

Clinical Policy: 56 hospitals now operate as Rural Emergency Hospitals, and two converted hospitals have closed

The University of North Carolina’s Sheps Center tracker lists 56 hospitals currently operating as Rural Emergency Hospitals (REH) in 21 states. By prior Medicare payment status they were 26 critical access hospitals, 14 sole community hospitals, 10 under the standard inpatient system and 6 Medicare-dependent hospitals. Two converters are labeled closed: Sturgis Hospital in Michigan and St. Mark’s Medical Center in La Grange, Texas. The tracker does not date its update, though its latest conversion entry is August 12, 2026. The trade-off an operator faces is fixed: an REH gives up all acute inpatient beds in exchange for a monthly facility payment plus 5 percent over standard outpatient rates, per the CMS REH fact sheet (we did not extract the current-year dollar amount). For emergency physician and hospitalist groups, each conversion removes inpatient admitting work and leaves the emergency department as the facility’s whole business. Update: the comment window on the Accreditation Council for Graduate Medical Education’s proposal to delete emergency medicine’s specific resident-hour and faculty-ratio rules closed October 22, per ACEP; we found no final text yet. Confidence: High on the tracker counts. Medium on what the closures prove, since they are two cases among 56.

The Operator Metric: Arbitration closures outran new filings by 34,330 in August and September

CMS’s No Surprises Act reports page shows 750,022 federal disputes initiated August 1 through September 30 and 784,352 closed, a net reduction of 34,330. That reverses June and July, when 712,561 were initiated and 671,465 closed, a net gain of 41,096 (July alone was +22,425, the figure we reported October 9). Over all four months the queue is up 6,766. Monthly filings are still climbing: 390,602 in September, up 9 percent from 359,420 in August. Track three numbers against your own receivables: days from filing to determination, days from determination to cash, and award as a percentage of QPA. The closure pace tells you the system can clear volume. It does not tell you the insurer paid. Confidence: High on the counts as posted by CMS. Medium on backlog direction, because the opening queue balance is not published.