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- Final Surprise Billing Regulation Outlines Updated Billing Dispute Settlement Process
On August 19, the Biden administration released the Requirements Related to Surprise Billing final rule, which follows a court decision supported by the CAP that struck down part of an earlier policy related to the independent dispute resolution (IDR) process. The final regulation instructs arbiters to consider an insurer's median contracted in-network rate and any additional information – including physician training and experience, patient acuity, and more – when determining the correct payment for a surprise bill. Further, the agencies make a point to avoid double-counting information, and the arbiter should not give weight to information related to a factor if the certified IDR entity determines the information was already accounted for in the calculation of the qualifying payment amount.
The CAP, the American Medical Association (AMA), and many other provider groups had warned that the initial requirements for the IDR process heavily favored insurers and would cause substantial harm to physicians. While the final regulation makes some improvements over the initial regulations, the CAP evaluates the final rule to ensure the new IDR requirements provide a fair system where physicians and health insurers can resolve disputes without one factor having more weight than another.