US HHS finalizes rule to streamline dispute resolution under No Surprises Act

May 28 (Reuters) – The U.S. Department of Health and Human Services (HHS) on Thursday finalized a rule to streamline how out-of-network payment disputes between providers and health insurers are resolved, aiming to cut administrative costs.

Here are a few details:

• The rule, part of a federal law banning surprise medical bills from providers outside patients’ insurance networks, aims to reduce ineligible disputes and lowering costs for providers and payers.

• “The No Surprises Act protects patients from unexpected medical bills while creating an arbitration process to resolve certain types of payment disputes between payers and providers, and this rule makes significant improvements to the arbitration,” said Centers for Medicare & Medicaid Services Administrator Mehmet Oz.

• The arbitration happens through the Federal Independent Dispute Resolution process, which the provider or insurer can initiate if they cannot agree on a payment amount for the out-of-network care.

• The final rule aims to cut administrative fee from $115 to $15 per party per dispute, potentially increasing participation, the agency said.

• It also increases flexibility in resolving a reasonable number of claims together in a single batch, reducing costs while speeding up decisions, HHS said.

• The rule also requires payers to use standardized claim codes when communicating about out-of-network services, helping providers determine early whether a claim qualifies for the IDR process, reducing ineligible disputes, HHS said.

• Under the rule, a new centralized platform to manage disputes would launch in phases beginning this year.

• The No Surprises Act was passed in 2020 to protect patients from surprise billing, which often arose when patients visited a hospital that was part of their insurance network, but later received a bill from doctors who are not part of the same insurance network as the hospital.

(Reporting by Mariam Sunny in Bengaluru; Editing by Joyjeet Das)