Lower No Surprises Act dispute fees officially go into effect
Starting Thursday, medical groups throughout the United States will pay lower fees related to No Surprises Act reimbursement disputes.
The NSA independent dispute resolution (IDR) process was updated by federal agencies in a final rule issued May 28. It included a slew of changes that affect radiology providers, among them, a notable reduction in IDR fees.
Prior to June 11, practices were required to pay a $115 filing fee to initiate disputes; the new $15 fee officially takes effect for all cases filed on or after the date. This change was made because many radiology claims were less than the total IDR fee amount previously.
The fee change was one of the aspects radiology stakeholders applauded. NSA administrative fees have been costly for groups; earlier this year Radiology Associates of North Texas—the largest independent imaging group in the United States—estimated that it will waste over $51 million on administrative costs related to NSA requirements.
“These are avoidable costs being forced into the healthcare system,” Kurt Schoppe, MD, president of Radiology Associates of North Texas, said in a statement May 19. “Ultimately, those expenses flow back to employers and plan sponsors through higher administrative overhead and increased healthcare costs.”
Alongside reduced fees, the expansion of batching rules also drew praise; those updates require insurers to include more information about IDR eligibility when they send payment notices or denials. Now, information on eligibility must be shared with both parties within five business days.
Other issues, such as enforcement measures that would penalize insurers for not paying providers after IDR determinations, were not addressed in the update. This has drawn criticism from radiology leaders, many of whom have been directly impacted by gaps in the NSA’s rules.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.