HHS raises IDR fees in proposed rule

Wednesday, October 4, 2023

HHS recently released the Federal Independent Dispute Resolution (IDR) Process Administrative Fee and Certified IDR Entity Fee Ranges proposed rule.

The rule would increase the administrative fee for IDR disputes from $50 to $150 per party per dispute in 2024. Additionally, HHS proposed to increase the upper ranges of certified IDR entity fees for single and batched determinations by 20% and 25%, respectively.

HHS first outlined the federal IDR process in an October 2021 interim final rule and related fee guidance. In the guidance, HHS set the administrative fee for both parties at $50 for calendar year (CY) 2022. The total administrative fees per year are estimated to be equal to the department’s expenditures to carry out the federal IDR process for that year, according to the rule.

The October 2021 interim final rule also established the range for fixed certified IDR entity fees for single and batched determinations as $200-$500 and $268-$670, respectively. HHS increased the upper ranges for CY 2023 in subsequent rules, allowing IDR entities to charge up to $700 for single determinations and $938 for batched determinations. Although HHS initially assigned the same administrative fee for CY 2023, the department later raised it to $350 in December 2022.

The following month, the Texas Medical Association filed a lawsuit against the department, saying the guidance was issued unlawfully without notice and comment rulemaking. In August, a Texas District Court sided with the Texas Medical Association and vacated the portion of the guidance that raised the administrative fee.

As a result of the district court’s opinion and subsequent lawsuits, HHS is now proposing to establish future administrative fee amounts and certified IDR entity fee ranges through notice and comment rulemaking. HHS is also proposing to allow certified IDR entities to charge up to $840 for single determinations and $1,173 for batched determinations in the same time period.

In addition, the department is proposing to retain the flexibility to update the fee amounts more or less frequently than annually to account for changes in the cost of carrying out the IDR process.

HHS is requesting feedback on fee methodology, implications of the Texas Medical Association lawsuits, and inflationary adjustments.

Revenue integrity professionals must ensure their organization is in compliance with the No Surprises Act. Although HHS has only instructed IDR entities to resume limited functions, it is of high priority to be in compliance when all processes are resumed. Review the proposed rule and provide comments to HHS. The comment period ends October 26.

Editor's note: Find more NAHRI resources on the No Surprises Act here.

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