Does the arbitrator have to pick the offer closest to the QPA?

No. Courts have struck down rules that told arbitrators to presume the QPA was correct. The arbitrator must consider the QPA along with the statutory factors and pick whichever of the two offers is more credible under all of them.

What can arbitrators not consider in federal IDR?

Billed charges and government program rates such as Medicare or Medicaid are excluded by the No Surprises Act. Everything else runs through the QPA plus the statutory factors.

What do awards look like relative to the QPA?

In the published 2023 through 2025 record, the typical award was about 4.7 times the QPA, and providers won 85.8 percent of decided disputes.

Answers / QPA in arbitration

How arbitrators treat the QPA in federal IDR

Certified IDR entities must consider the qualifying payment amount, but courts have struck down rules that told arbitrators to presume the QPA was correct. Arbitrators weigh it alongside training and experience, patient acuity and case complexity, market share, scope of services, and prior contracting history, and may not consider billed charges or government rates. The typical published award is about 4.7 times the QPA.

From presumption to factor

The original rules effectively made the QPA the answer: arbitrators were told to select the offer closest to it unless clearly convincing evidence said otherwise. Litigation dismantled that. Courts have struck down rules that told arbitrators to presume the QPA was correct, holding that the No Surprises Act makes the QPA one consideration among several, not a rebuttable baseline. Today's certified IDR entities evaluate offers against the full statutory list.

What the arbitrator weighs

Alongside the QPA, the arbitrator considers the provider's training, experience, and quality; the acuity of the patient and complexity of the case; the market share of each party in the region; the scope of services the provider or facility offers; and the parties' prior contracting history, including good faith negotiation. Two inputs are banned outright: the provider's billed charges and government program rates like Medicare. The fight is therefore never list price against QPA; it is a documented story about this clinician and this case against a six-year-old median.

Why awards clear the QPA

The published record for 2023 through 2025 shows providers winning 85.8 percent of decided disputes with typical awards around 4.7 times the QPA. The mechanics explain the margin. The QPA is the payer's own January 2019 contract median indexed by CPI-U, which compounds slower than negotiated rates have moved, and baseball-style selection means the arbitrator picks whichever single offer is more credible overall. A provider offer grounded in acuity, credentials, and the service's real market tends to beat an offer that is just the QPA restated.

Arguing against the anchor

The offers that win treat the QPA as a number to be examined rather than feared: confirm the required disclosures came, pull the methodology details the rules let you request, flag database-derived or downcoded QPAs, and put the statutory factors on paper with specifics. When nobody challenges the number, the arbitrator has little reason to move off it.

Put the factors on paper

Lido IDR builds offers around the statutory factors and the published record, not the payer's anchor, for a flat fee per arbitration. Talk to an IDR specialist.