The Centers for Medicare & Medicaid Services announced an amendment to the administrative fee for the Federal Independent Resolution (IDR) process, increasing it from $50 to $350 per party.
The Departments of Health and Human Services, Labor, and the Treasury have amended the “Calendar Year 2023 Fee Guidance for the Federal Dispute Resolution Process under the No Surprises Act.” The update, initiated on Jan. 1, 2023, increased the administrative fee for the Federal IDR from $50 to $350 per party for disputes initiated during the 2023 calendar year. According to the amendment, this change was made due to a supplemental data analysis and increasing expenditures in carrying out the Federal IDR process since the development of the prior 2023 guidance, released on Oct. 31, 2022. CMS notes no other changes have been made to the 2023 certified IDR entity fee ranges for single or batched determinations.
When initially setting the administrative fee for 2023 in the prior 2023 guidance, CMS says the costs to administer the Federal IDR process during 2022, including staffing and contracting costs related to certification and oversight of certified IDR entities, were considered. The amended administrative fee reflects the additional cost to administer the Federal IDR process as a result of the enhanced role of the Departments of Health and Human Services, Labor, and the Treasury in the 2023 calendar year in conducting pre-eligibility reviews allowing certified IDR entities to complete their eligibility determinations more efficiently.
CMS explains that the caseload from April 15, 2022, to Dec. 5, 2022, was nearly 10 times greater than initially estimated over the course of a full calendar year. In addition, noninitiating parties challenged the eligibility of more than 68,000 disputes for the Federal IDR process. “This situation has resulted in low collections of the administrative fee relative to the volume of disputes processed in the portal, and … low collections of the administrative fee relative to the Departments’ expenditures in the first two calendar quarters of Federal IDR process operations,” the amendment states.
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