September 28, 2023

ACR Provides Input to Congress on Challenges With Implementation of Surprise Billing Legislation

Government Proposes Significant Fee Increases for Independent Dispute Resolution

The American College of Radiology® (ACR®) communicated to the U.S. House Committee on Ways and Means the challenges impacting physicians as a result of inappropriate regulations issued to implement the No Surprises Act (NSA). The committee was instrumental in development of the 2020 law and comments were submitted in response to a Sept. 19 hearing, “Reduced Care for Patients: Fallout From Flawed Implementation of Surprise Medical Billing Protections.”

ACR’s feedback focuses on barriers to accessing the independent dispute resolution process (IDR), batching, and reasonable and timely payment. This input is especially timely following the release of guidance by federal agencies outlining a new fee structure associated with the IDR.

The ACR has prepared a detailed summary of the U.S. Departments of the Treasury, Labor, and Health and Human Services proposed rule that outlines policies related to the No Surprises Act (NSA) independent dispute resolution (IDR) process fees. If finalized, the rules would triple the current $50 administrative fee to $150, and substantially increase the fees paid to IDR entities used to determine the most accurate payment rate for certain out-of-network services.

In addition to setting a methodology for the calculation of the administrative fee paid by both parties in the IDR process, the departments propose to increase the upper limit of the IDR entity fee paid by the party whose offer is not selected by 20% for single claims and 25% for batched claims — like claims that are grouped together for IDR consideration. In addition, the departments propose to allow a fixed tiered fee within the range of $75 to $250 for every additional 25-line items within a batched dispute. These additional fees disincentivize providers from submitting large batches of claims and will likely result in multiple submissions of smaller batches.

The departments propose to use the rulemaking process with comment to set the IDR fees moving forward, but state in the rule that the final fees may differ from the proposal if additional data on expenditures and collections become available between the publication of the proposed and final rules. They also propose to allow the fee to be updated more or less frequently than annually, using the rulemaking process.

For more information or if you have questions, contact Katie Keysor, ACR Senior Director of Economic Policy.