Administration Releases Long-Awaited No Surprises Act Final Rule

Last week, the Departments of Health and Humans Services, Labor, and the Treasury issued the Independent Dispute Resolution Operations final rule. The final rule can be considered positive for physicians and looks to streamline the dispute process and require more information to be provided to physicians. It increases the formality of the open negotiations process and reduces the costs of disputing a claim.

In line with many of the American Medical Association’s previous recommendations, the rule:

• Requires plans to use claim adjustment reason codes and remittance advice remark codes, in both paper and electronic remittance advice to assist in clarifying eligibility.
• Requires more information to be disclosed with the initial payment or notice of denial of payment.
• Streamlines the efficiency and increases the formality of the open negotiation process by requiring that the initiation and response take place via the federal IDR portal.
• Requires plans and issuers to register in the federal IDR portal so that their information is available to physicians and other parties.
• Allows for more flexibility in batching items or services into a single dispute, including extending the number of allowed line items from 25 to 50.
• Reduces the administrative fee from $115 to $15.
• Shortens the “cooling off period” from 90 to 30 days for batched claims.

Many of these new provisions will require further guidance, potentially extending their implementation dates for months or even years. Fortunately, the reduced administrative fee took effect on June 11, and new requirements on information to be shared along with the QPA are effective 60 days after publication (Aug. 3).