Federal Updated Fees for No Surprises Act IDR Resolution Process
Since its creation, the No Surprises Act (NSA), which took effect on January 1, 2022, has seen some growing pains. Notably, four lawsuits have challenged the Independent Dispute Resolution (IDR) procedure. When there is disagreement over the amount to be paid for out-of-network treatments, this procedure is employed by health plans, medical facilities, and air ambulance services. A qualified IDR entity evaluates the details of the dispute, including the goods or services received, and decides on the ultimate payment amount before deciding on a resolution. dispute is decided upon after a certified IDR entity reviews the specifics of the dispute, including items or services received, and determines the final payment amount.
Texas Medical Association, et al. v. U.S. Department of Health & Human Services, et al. (TMA IV), the most recent lawsuit contesting the administration of this process and the assignment of fees, contested the IDR admin fee increase from $50 to $350, claiming it was implemented without giving notice or opportunity for comment. Additionally, providers’ ability to group claims together was restricted by the Departments of Labor, Health and Human Services, and Treasury. The lawsuit claimed that this restriction along with the cost increase rendered using the dispute procedure unfeasible for providers with primarily low-dollar claims.
Following the ruling in favor of the providers in TMA IV, the Departments finalized the newly adjusted costs related to the IDR process on December 18, 2023, by releasing the Federal Independent Dispute Resolution (IDR) Process Administrative Fee and Certified IDR Entity Fee Ranges final rule.