After Legal Setbacks, New Rules Update The Dispute Resolution Process
Surprise Billing Final Rule
The White House announced on Friday a final rule updating the arbitration process that insurers and providers can use to settle out-of-network billing disputes.
Following several legal setbacks, the newly released final rules implement the No Surprises Act, which protects consumers from unexpected medical bills. The final rules, released by the Department of Health and Human Services (HHS) and the Department of Treasury and Labor (DOL), provide new details and additional guidance for the independent dispute resolution process (IDR). The IDR process is utilized to decide an out-of-network rate for services and items in instances when talks break down between payers and providers.
In this final rule, the Biden administration removed the requirement that arbitrators must give additional weight to the out-of-network rate, including what is known as the qualified payment amount (QPA) over other allowable factors.
Stay tuned for additional guidance as it become available.