Last week, the Biden administration announced a proposed rule through the U.S. Department of Health and Human Services (HHS), Labor and the Treasury Department that would implement the independent dispute resolution process (IDR process) outlined by the No Surprises Act, which seeks to protect patients and medical services consumers from surprise bills.
According to the Fact Sheet from the Centers for Medicare and Medicaid Services (CMS), the proposed rule incorporates feedback and challenges raised by stakeholders, and aims to improve communications between payers and providers. The Federal IDR process will be centralized around a negotiation process portal and the aggrieved party will be required to open a negotiation with proper notice and a copy of remittance advice or notice of denial of payment. The rule would also establish a departmental eligibility review process that would support determinations to facilitate faster review processing by certified IDR entities.
The departments also proposed introducing a reduced administrative fee structure for parties in low-dollar disputes in order to “promote equitable access” to initiate the IDR process, according to the HHS press release.
From HHS Secretary Xavier Becerra:
The Biden-Harris Administration continues to take actions to protect patients from junk health insurance and unfair billing practices. This rule is the next step in ensuring we take patients out of the middle of billing disputes between insurers and health care providers. Eliminating surprise medical bills, reducing the burden of medical debt, and curtailing junk insurance plans continue to be high priorities. HHS will continue to do everything in our power to protect patients.
The No Surprises Act is already having a noticeable impact on the bottom line of hospitals due to increased costs from staffing firms. According to STAT News, physician staffing services can no longer rely on out-of-network payments from surprise bills to pad the balance sheet, so the services are instead juicing their contracts with hospitals, which are experiencing a national workforce shortage and have little room to negotiate. Apparently, this was especially true while the federal IDR process for out-of-network disputes was on hold.
From Ryan Stanton, emergency room provider and spokesperson for the American College of Emergency Physicians:
It’s the only industry where you can provide a high-level service and then those responsible for paying for it are like, ‘Hmm, I guess not. I’m not really interested.’