The federal government issued a final rule on Monday, setting the administrative fee for utilizing the independent dispute-resolution process under the No Surprises Act at $115.
This week’s action comes in response to a lawsuit filed by the Texas Medical Association earlier this year, challenging a 600% increase, hiking the charge from $50 to $350. TMA ended up prevailing, with a federal judge striking down the new amount. Radiology advocates hailed the ruling as a “significant victory” for the specialty at the time.
The NSA provides a forum for physicians and commercial insurers to settle disputes over out-of-network payments, protecting patients from receive the typical “surprise” bill that results. Under the statute, both sides must pay this nonrefundable fee, aimed at covering the costs of administering the program.
“To increase transparency regarding how the administrative fee is determined in accordance with this statutory requirement, the departments are finalizing the administrative fee amount based on a methodology that divides the departments’ estimated expenditures to carry out the federal IDR process by the estimated total number of administrative fees paid in the year,” CMS said in a Dec. 18 fact sheet. “The final rule also provides that the administrative fee amount will be established no more frequently than once per calendar year, in response to comments requesting more stability in the administrative fee amount,” the agency added later.
The $115 fee applies to disputes initiated on or after Jan. 1. CMS said the administration plans to leave the amount untouched, until the feds propose and finalize any future changes in subsequent rulemaking.
Meanwhile, CMS reported that the administration is finalizing a proposal to establish ranges for fees charged by arbitrators who handle these disputes. The proposal would set the certified IDR entity fee range at $200 to $840 for single determinations and $268 to $1,173 for batched determinations. And for batched determinations that exceed 25 dispute line items, the feds are finalizing a proposal that IDR entities may set a fixed fee within the range of $75 to $250 for each increment of 25 dispute line items included in the request.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.