On September 20, 2023, HHS, DOL, and IRS (the departments) issued proposed rules outlining the fees established in the No Surprises Act for the Federal Independent Dispute Resolution (IDR) process.
These proposed rules would amend existing regulations to provide that the administrative fee amount charged by the departments to participate in the Federal IDR process and the ranges for certified IDR entity fees for single and batched determination will be established by the departments in notice and comment rulemaking, rather than in guidance published annually.
The issuance of the proposed rules follows a Texas district court decision issued on August 3, 2023, which vacated a portion of the departments’ December 2022 guidance that significantly increased the IDR administrative fees and imposed restrictions on batching-related claims in a single payment dispute. In this case, the judge agreed with the Texas Medical Association and other healthcare providers that the issuance of the rule violated the Administrative Procedures Act’s notice-and-comment requirement. This case was covered in the August 17, 2023, edition of Compliance Corner in an article regarding department-issued FAQs that address the impact of the court’s ruling on IDR fees.
The proposed rules would increase the current administrative fee from $50 to $150 per party per dispute, which would remain in effect until changed by subsequent rulemaking for disputes initiated on or after the later of the effective date of final rules or January 1, 2024. The departments also proposed certified IDR entity fees ranging from $200 to $840 for single determinations and $268 to $1,173 for batched determinations. Certified IDR entities will continue to be permitted to set their fees within the ranges proposed in the proposed rules — if finalized.
Public comments on the proposed regulations are due within 30 days after the proposed regulations are published in the Federal Register.
Employers with self-insured plans that are involved in payment disputes with out-of-network providers should be aware of this development and consult with their TPA or legal counsel if questions arise.
Federal IDR Process Administrative Fee and Certified IDR Entity Fee Ranges Proposed Rule »
No Surprises Act Overview of Rules and Fact Sheets »
PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.
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