The American College of Radiology® (ACR®) recently urged the U.S. Departments of the Treasury, Labor, and Health and Human Services to keep the administrative fee for the Federal Independent Dispute Resolution (IDR) at a level that allows imaging providers access to IDR in cases where insurer payments for applicable out-of-network services are insufficient.
The proposed rule outlines a methodology for calculating the administrative fee required to be paid by both providers and payers to enter the IDR process and suggests the fees may be updated through rulemaking “more or less frequently than annually.” The current fee is $50, but the departments propose a $150 fee beginning Jan. 1, 2024. The proposed methodology considers the expected cost of operating the federal IDR process, as well as the number of disputes expected to be processed in the year. ACR supports the use of the rulemaking process rather than guidance documents to set the IDR fees as it allows the opportunity for stakeholder comment, however, the College asked that the fees not be updated more frequently than annually. The ACR also pointed to flaws in the proposed calculation methodology that result in higher fees.
The ACR also highlighted the importance of providers having the ability to “batch” claims into fewer IDR submissions to promote efficiency within the system. Batching similar claims is particularly important for imaging as a majority of disputed claims fall below the proposed $150 administrative fee required to enter IDR. The non-refundable administrative fee is paid by both parties. In addition to this fee, the IDR entity fee is also paid by both parties but is returned to the prevailing party when the dispute is resolved. The ACR did not oppose the proposed increase in IDR entity fees. The departments proposed additional fees for larger batches, with added cost for every additional 25 claims. The ACR understands the added costs of processing large batches but asked that the additional fee be imposed for every additional 50 claims rather than 25.
The ACR strongly supports the NSA “hold harmless” provisions, removing patients from reimbursement disputes between insurers and providers. The College appreciates the NSA’s intended balanced approach with respect to insurance companies and medical practices. The law was designed to end the problem of surprise medical billing while preserving access to care by protecting good-faith negotiations between insurance companies and provider groups, giving neither side unbalanced leverage in network contract negotiations.
For more information or if you have questions, contact Katie Keysor, ACR Senior Director of Economic Policy.