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- CAP Supports the Restructuring of the Independent Dispute Resolution Process
The CAP strongly supported significant improvements to the independent dispute resolution (IDR) process detailed in a proposed regulatory change by federal departments charged with overseeing the implementation of the 2020 No Surprises Act. The 2020 law established the IDR process to settle disagreements between physicians and insurers over out-of-network bills through a third-party entity. The CAP has supported the creation of the IDR process, but also challenged the government’s implementation of the law to ensure that pathologists can resolve disputes with health plans and receive adequate pay for their services.
In a January 2 letter, the CAP urged the Department of Health and Human Services (HHS), jointly with the departments of Labor and the Treasury, to move forward with new disclosure requirements, centralizing the open negotiations process, increasing flexibility around batching, and promoting equitable access to IDR for low-dollar disputes. The CAP also encouraged the departments to increase the ease of submitting a formal complaint against an insurer and to strengthen enforcement, including financial penalties, of No Surprises Act dispute resolution requirements.
On December 15, the federal government reopened the IDR process and began accepting all dispute types after being shut down since August.
On December 18, the departments issued a final rule outlining the fees for the IDR process. This rule set an administrative fee amount of $115 per party for disputes, which was down from a proposed $150 fee amount. Download the final rule fact sheet.