The American College of Radiology (ACR) remains concerned about a federal ruling that would increase the cost of independent dispute resolution (IDR) fees as part of the No Surprises Act.
The college on December 20 issued its statement in the wake of a December 18 ruling by the U.S. departments of the Treasury, Labor, and Health and Human Services. The ruling outlined policies related to the No Surprises Act’s IDR process administrative fee, which will more than double the fee from $50 to $115 per dispute. The new fee will take effect 30 days after publication of the rule in the Federal Register, which could come as soon as January.
The departments earlier in 2023 proposed an increase to $350 for the IDR administrative fee. However, the Texas Medical Association, the Texas Radiological Society, Houston Radiology Associated, and other entities issued a lawsuit against the federal government in the U.S. District Court for the Eastern District of Texas. The lawsuit claimed that the fee increase violated federal law.
The court in August ruled in favor of ACR members and other physicians. It decided that the government’s rule violated federal law and the administrative fee was lowered back to $50.
The IDR administrative fee considers the expected cost of operating the federal IDR process along with the number anticipated disputes started within the calendar year. The finalized policy also allows for the fees to be updated not more than annually.
The ACR stated that “most” imaging claims are less than the finalized $115 administrative fee. Also, providers and payers must pay an IDR entity fee. This is paid only by the nonprevailing party to refund the prevailing party’s entity fee.
The finalized entity fees will be in the range of $200 to $840 for single determinations and $268 to $1,173 for batched determinations. IDR entities can also set a fixed fee within the range of $75 to $250 for each additional 25 line items after the 25th item in batched disputes.
And while the court rulings led to suspension of the IDR process, the government on December 15 announced that the IDR portal was reopened for submitting and processing all disputes. This included batched claims that had been on hold since August 3.
In a separate proposed rule, the departments have proposed expanded batching guidelines and a policy to allow a reduced administrative fee for low-dollar claims. That rule is in the comment period.
“The ACR is in the process of finalizing comments to be submitted before the January 2 deadline,” the college stated.
The ACR’s full statement can be read here.
