Feds Finalizes $115 Participation, Other Fees for IDR Process
The new fees come after a court ruling vacated previous guidance used to set the administrative payment amount for the federal IDR process.
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By - The Departments of Health and Human Services, Labor, and the Treasury (the Departments) have updated the amount each party must pay to resolve surprise medical bills through the federal independent dispute resolution (IDR) process.
The Departments said in a final rule released yesterday that each party will have to pay $115 for disputes initiated on or after Jan. 20th, or 30 days after the publication of the final rule in the Federal Register. The Federal Register has scheduled publication for Dec. 21st.
The final rule also solidified future certified IDR entity fees, finalizing a fee between $200 and $840 for single determinations and a fee between $268 and $1,173 for batched determinations. However, the Departments will charge between $75 and $250 if batched determinations exceed 25 dispute line items. The fees will apply to each increment of 25 dispute line items included in the batch dispute.
The updated fees will remain in effect until the Departments propose and finalize different certified IDR entity fee ranges in later notice and comment rulemaking.
Updated federal IDR process fees come after a district court in Texas vacated parts of previous guidance issued by the Departments and used to establish administrative fee amounts for 2023. The guidance specifically boosted the per-party participation fee from $50 to $350, an increase of 600 percent.
The Texas Medical Association (TMA) sued the Departments over the price hike, arguing that the increase “not only will make the process significantly more expensive for all IDR participants but will make it cost-prohibitive for many physicians to access IDR at all.”
The US District Court for the Eastern District of Texas ruled in favor of TMA in August, striking down the $350 fee because it was issued without notice and comment period. The court also found the increase to be arbitrary and capricious.
The Departments issued a new methodology for calculating IDR process fees in the new final rule. They said in the rule that methodology will divide the Departments’ estimated costs of carrying out the federal IDR process by the estimated total number of administrative fees paid in the year.
The total number of administrative fees will be based on the projected total number of administrative fees paid to certified IDR entities versus the projected total number of disputes closed, as proposed in a previous rule, the final rule added.
Additionally, the final rule stated that the administrative fee amount will be set no more frequently than once per calendar year to provide more stability in the administrative fee amount, as commenters requested.
