The U.S. Departments of the Treasury, Labor, and Health and Human Services issued a new final rule Dec. 18, that outlines policies related to the No Surprises Act (NSA) independent dispute resolution (IDR) process administrative fee, more than doubling the current fee.
The rule finalizes a methodology for calculating the administrative fee required to be paid by both providers and payers to enter the IDR process. The current fee is $50, but the departments finalized a $115 fee beginning 30 days after publication of the rule in the Federal Register, likely in January. The administrative fee calculation methodology considers the expected cost of operating the federal IDR process, as well as the number anticipated disputes initiated in the year. The departments previously proposed to allow the fee to be updated “more or less frequently than annually,” using the rulemaking process, but the finalized policy allows for the fees to be updated not more than annually.
The departments previously increased the IDR administrative fee to $350 on Jan. 1, 2023, with less than two weeks advance notice to stakeholders. The Texas Medical Association (TMA), Texas Radiological Society, Houston Radiology Associated and others, brought a lawsuit against the federal government in the U.S. District Court for the Eastern District of Texas that charged the government’s fee increase violated federal law. The court ruled for American College of Radiology® (ACR®) members and other physicians, deciding that the government’s rule implementing the NSA violated federal law on Aug. 3, and the administrative fee was lowered back to $50.
In addition to the administrative fee, providers and payers must pay an IDR entity fee, which is ultimately paid only by the non-prevailing party as the prevailing party’s entity fee is refunded. The departments finalized an IDR entity fee range of $200-$840 for single determinations and $268-$1,173 for batched determinations. Further, for batched determinations exceeding 25 dispute line items, the departments finalized a policy that certified IDR entities may set a fixed fee within the range of $75-$250 for each increment of 25 dispute line items included in the batched dispute, beginning with the 26 line item.
The ACR remains concerned about access to IDR for radiology as most imaging claims are less than the finalized administrative fee of $115. In a separate proposed rule for IDR operations, the departments have proposed expanded batching guidelines and a policy to allow a reduced administrative fee for low-dollar claims.
The IDR process was suspended following recent court rulings, but the government announced Dec. 15 that the IDR portal was reopened for submission and processing of all disputes, including batched claims on hold since Aug. 3.
For more information or if you have questions, contact Katie Keysor, ACR Senior Director of Economic Policy.