Surprise Billing

Feds Finalizes $115 Participation, Other Fees for IDR Process

December 19, 2023 - 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...


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Surprise Billing Proposals Aim to Streamline IDR Process

by Victoria Bailey

The Biden-Harris Administration has released a proposed rule to improve the independent dispute resolution (IDR) process for surprise billing by addressing payer-provider communication and adjusting...

What the Latest Court Decisions Mean for the Federal IDR Process

by Jacqueline LaPointe

The latest court rulings in a series of legal challenges have left the No Surprises Act’s (NSA’s) federal independent dispute resolution (IDR) process in limbo yet again. In an announcement on the CMS website on August 25th,...

CMS Reduces No Surprises Act Fee After Court Vacates Price Hike

by Jacqueline LaPointe

CMS has reinstated the $50 fee for initiating a payment dispute under the No Surprises Act following a court ruling striking down a price hike earlier this year. The non-refundable administrative fee...

Independent Dispute Resolution Case Load 14X More Than Expected

by Jacqueline LaPointe

Nearly a year after the federal government launched the independent dispute resolution (IDR) process under the No Surprises Act, over 330,000 balance billing disputes have been filed, nearly 14 times...

CMS Resumes IDR Payment Determinations Under No Surprises Act

by Jacqueline LaPointe

CMS has instructed certified independent dispute resolution (IDR) entities to resume payment determinations for disputes involving items or services furnished on or after Oct. 25, 2022, according to...

Lessons from the NSA’s Independent Dispute Resolution (IDR) Process

by Jacqueline LaPointe

Nearly a year since the federal government launched the independent dispute resolution (IDR) process, Becky Greenfield, partner at Wolfe Pincavage, has learned a few things about the No Surprises Act (NSA) and out-of-network claim...

TX Physicians Win No Surprises Act Rule Court Case

by Jacqueline LaPointe

A federal judge has ruled in favor of the Texas Medical Association’s (TMA’s) challenge of a No Surprises Act rule released by HHS to flesh out the independent dispute resolution (IDR)...

Federal IDR Process Faces More Disputes Than Expected, Backlog Growing

by Jacqueline LaPointe

Payers and providers are utilizing the independent dispute resolution (IDR) process far more than the government expected to resolve disagreements about payment for items and services covered by the...

HHS Gives Providers More Time for Good Faith Estimate Compliance

by Jacqueline LaPointe

HHS has extended enforcement discretion for the delivery of some good faith estimates (GFEs) under the No Surprises Act, according to new guidance. The guidance released by HHS on Friday says that CMS...

House Committee Requests Changes to Final Surprise Billing Rule

by Victoria Bailey

Leaders of the House Committee on Ways and Means have voiced concerns that the final surprise billing rule on the independent dispute resolution (IDR) process continues to violate the No Surprises...

MGMA Requests Modifications of Good Faith Estimate Requirements

by Victoria Bailey

The Medical Group Management Association (MGMA) has asked HHS, the Department of Labor, and the Department of the Treasury (the Departments) to modify the good faith estimate (GFE) and advanced...

Some State Surprise Billing Resolution Processes Favor Providers

by Jacqueline LaPointe

The No Surprises Act gives states the opportunity to enforce surprise billing provisions, but most are leveraging the federal independent dispute resolution process to determine out-of-network rates,...

Practices Most Frustrated With Prior Auths, Then No Surprises Act

by Jacqueline LaPointe

Prior authorizations are still the top regulatory burden according to executives from group practices, while No Surprises Act compliance has debuted on the list this year as the second most burdensome...

TX Doctors Sue Feds Over Surprise Billing IDR Process, Again

by Jacqueline LaPointe

The Texas Medical Association (TMA) is once again suing the federal government over the surprise billing law enacted earlier this year. TMA sued federal regulators and won last year. At the time, the...

HHS Requests Stakeholder Feedback on Good Faith Estimate Requirements

by Victoria Bailey

HHS, along with three other federal agencies, has issued a request for information (RFI) to gather stakeholder feedback on the advanced explanation of benefits (AEOB) and good faith estimate (GFE)...

State Surprise Billing Laws Impact Out-of-Network Provider Charges

by Victoria Bailey

State surprise billing laws that allow arbitrators to consider provider charges when determining out-of-network payment amounts for surprise medical bills led to an increase in billed charges for...

CMS Releases Guidance on Independent Dispute Resolution Process

by Victoria Bailey

CMS has launched a webpage containing resources and guidance regarding the federal independent dispute resolution (IDR) process under the No Surprises Act. The process helps determine reimbursement...