The Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management on Thursday issued a final rule aimed at making the federal Independent Dispute Resolution (IDR) process under the No Surprises Act more efficient and transparent. The No Surprises Act (P.L. 116-260), which is designed to protect patients from unexpected medical bills, created an arbitration process to resolve out-of-network payment disputes between payers and providers, referred to as the IDR process.
The final rule will allow for up to 50 items and services (or “line items”) to be batched in the same payment dispute. These claims may be batched when they involve a single patient on the same or consecutive dates of service billed together and when claims share the same service code. Additionally, it increases access to the IDR process by reducing the administrative fees on disputes from $115 to $15. The rule streamlines communication between payers, providers, and IDR entities and clarifies timelines and processes. The rule would require payers to use standardized claims codes in communications about out-of-network care, enabling providers to determine whether a particular claim is eligible for IDR. Notably, the Centers for Medicare & Medicaid Services announced plans to launch a new, centralized platform for monitoring IDR disputes, called IDR Gateway. This tool will enable users to initiate a dispute, track the status of open cases, and manage other activities.
The AAMC supported many of these changes in its comments (PDF) on the proposed rule [refer to Washington Highlights, Jan. 12, 2024].