HHS updates IDR fees and processes in final rule
HHS finalized certain fees and processes associated with the federal independent dispute resolution (IDR) process under the No Surprises Act in a final rule released on December 18.
To participate in a determination with a certified IDR entity, each party must pay a non-refundable administrative fee. HHS finalized an administrative fee amount of $115 per party for disputes initiated on or after the effective date of the final rule. The effective date is 30 days after the rule’s publication in the Federal Register, which is currently scheduled for December 21.
HHS also finalized certified IDR entity fee ranges of $200–$850 for single determinations and $268–$1,173 for batched determinations. For batched determinations exceeding 25 dispute line items, certified IDR entities may now set a fixed fee between $75 and $250 for each increment of 25 dispute line items, beginning with the 26th item.
The administrative fee amount and certified IDR entity fee ranges will remain in effect until subsequent notice and comment rulemaking, according to the rule. Although HHS finalized the requirement that these can be set no more frequently than once per calendar year, the department noted that they can be set less frequently.
Revenue integrity professionals must ensure their organization is in compliance with the No Surprises Act. Review the rule and CMS’ fact sheet to understand HHS’ finalized changes to the federal IDR process.
Editor's note: Find more NAHRI resources on the No Surprises Act here.