On December 21, 2023, the Departments of Health and Human Services, Labor and the Treasury (collectively, “the Departments”) released a final rule that sets the applicable fees for participating in the No Surprises Act’s (“NSA”) Independent Dispute Resolution (“IDR”) process. The new administrative fee and IDR entity fee ranges established under the final rule are effective January 22, 2024.
Finalized IDR Fees and Methodology
IDR is a process by which the appropriate payment rate is determined for those services that the NSA prohibits an out-of-network provider from balance billing a patient. For a more detailed discussion of the NSA IDR process, please see our previous articles here and here.
This final rule stems from an August 3, 2023 ruling by the U.S. District Court for the Eastern District of Texas that the Departments’ increase of the IDR fees through guidance documents violated the Administrative Procedure Act. Consequently, the final rule clarifies that the Departments will update these fees only through notice and comment rulemaking and will do so no more than annually.
The Departments clarified that the methodology used to set the IDR administrative fees for 2024 was to divide the total projected IDR expenditures by the projected number of administrative fees to be paid by disputing parties during the same period. The Departments also noted that they anticipate a reduction in their cost in administering the IDR process in 2024 to result from rule changes that should significantly reduce the Departments’ role in determining each claim’s eligibility for IDR. Collectively, these adjustments resulted in a finalized IDR administrative fee amount of $115 per party, per dispute.
The Departments set a permitted range of fees for certified IDR entities in 2024 between $200 and $840 for single claim determinations and between $268 and $1,173 for batched determinations. Certified IDR entities are also permitted to set a fixed fee between $75 and $250 per each 25-line item increment for batched determinations that exceed 25 line items. Each certified IDR entity must set their fees within these ranges, once per calendar year and may update their fees one additional time per calendar year, subject to the approval of the Departments.
Practical Takeaways
- Interested parties can anticipate a new proposed rule each year to address fees for the IDR process and thus an annual opportunity to submit comments for the Departments’ consideration.
- Hall Render will continue to monitor all guidance, rules and other relevant updates to the IDR process and will provide timely updates.
For more information on surprise billing or assistance with the IDR process, please contact:
- Lisa Lucido at (248) 457-7812 or llucido@hallrender.com;
- Angela Smith at (317) 977-1448 or asmith@hallrender.com;
- Benjamin Fee at (720) 282-2030 or bfee@hallrender.com;
- Matthew Reed at (317) 429-3609 or mreed@hallrender.com;
- Zeke Shen at (414) 721-0912 or zshen@hallrender.com; or
- Your primary Hall Render contact.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer an individual’s questions that may constitute legal advice.
