CMS finalizes updated fees for No Surprises Act dispute resolution

The Biden administration on Monday released amended fees related to independent dispute resolution under the No Surprises Act.

The Centers for Medicare & Medicaid Services had established initial fees, but the guidance was vacated by a Texas judge in a win for providers, forcing the agency to pause IDR. The independent dispute resolution approach is meant to resolve disagreements over out-of-network charges that payers and providers are unable to settle themselves.

Should a payer and provider be unable to reach an agreement within 30 days, the dispute will be sent to arbitration. CMS said that it needed to increase fees associated with this process from $50 to $350 to cover expenses.

In the amended final rule, CMS said it will instead set an administrative fee of $115 for disputes that are subject to the rule. A separate rule, which is up for comment until Jan. 2, adjusts the fees for disputes initiated after Jan. 1, 2025.

CMS said it doesn't plan to adjust the fees more than once per calendar year, as submitted comments sought greater stability around the fee amounts.

"The estimated expenditures for the administrative fee calculation are determined using the estimated costs to the Departments, such as costs to maintain, operate and improve the Federal IDR portal to carry out the Federal IDR process," the agency wrote in a fact sheet.

In addition, CMS outlined ranges for certified IDR entity fees, which the arbiters charge for determinations. Under the rule, the agency finalized a range of between $200 and $840 for a single determination and between $268 and $1,173 for batch rulings.

These fees are also set annually, and IDRs can request to update them once each year, which the feds must approve.