Proposed Rule Aims to Enhance No Surprises Act Independent Dispute Resolution Process

Proposed Rule Aims to Enhance No Surprises Act Independent Dispute Resolution Process - Healthcare Law Update - November 2023 - Brach Eichler
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11/30/2023

On October 27, 2023, the Departments of Health and Human Services, Labor, and the Treasury and the Office of Personnel Management issued a proposed rule to improve the functioning of the Federal Independent Dispute Resolution (IDR) process outlined in the No Surprises Act (NSA).

If finalized, the proposed rule would, among other things:

• Improve communication and information exchange during the open negotiation period before parties initiate the IDR process by requiring a party to notify the other party and the Departments about commencing the 30 business-day open negotiation period and requiring the other party to provide a response by the 15th business day of the open negotiation period.

• Encourage efficiencies in the IDR process by allowing batching of: (1) items and services furnished to a single patient on one or more consecutive dates and billed on the same claim form, (2) items and services billed under the same service code or a comparable code under a different procedure code system, and (3) anesthesiology, radiology, pathology, and laboratory items and services billed under service codes in the same CPT code category, as specified by the Departments.

• Quicken eligibility determination by requiring certified IDR entities to determine whether a claim is eligible for the IDR process within 5 business days of final certified IDR entity selection and to notify both disputing parties and the Departments of such determination.

• Modify non-refundable administrative fee collection by requiring disputing parties to pay the fee directly, with the initiating party required to pay within two days of IDR entity selection, and the non-initiating party within two days of an eligibility determination notice. Failure to pay would result in dispute closure or non-consideration of an offer. The proposed rule also includes debt collection procedures for non-initiating parties failing to pay promptly.

• Amend the extenuating circumstances in which applicable periods of time may be extended by the Departments.

Interested parties have until January 3, 2023 to submit comments on the proposed rule.

Click Here to read the entire November 2023 Healthcare Law Update now!

For more information, contact:
Joseph M. Gorrell | 973.403.3112 | jgorrell@bracheichler.com
Richard Robins | 973.447.9663 | rrobins@bracheichler.com
Vanessa Coleman | 973.364.5208 | vcoleman@bracheichler.com

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Related Practices:   Healthcare Law

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