Health insurers and medical providers who can’t agree on the cost of a treatment or service will soon be settling their differences through an independent resolution system that will render decisions that shape billions of dollars in healthcare spending.d
On September 30, 2021, an interim final rule with comment period, entitled “Requirements Related to Surprise Billing; Part II” was released.
The rule implements additional protections against surprise medical bills under the No Surprises Act, including provisions related to the independent dispute resolution process, good faith estimates for uninsured (or self-pay) individuals, the patient-provider dispute resolution process, and expanded rights to external review.
The September 30, 2021 rule establishes the federal independent dispute resolution process that Out Of Network (OON) providers, facilities, providers of air ambulance services, plans, and issuers in the group and individual markets may use to determine the OON rate for applicable items or services after an unsuccessful open negotiation.
Not all items and services are eligible for the federal independent dispute resolution process.
This process applies only to those services for which balance billing was prohibited under the “Requirements Related to Surprise Billing; Part I” rule.
In conjunction with the release of this interim final rule, the Departments and OPM launched a website focused primarily on providing general information about No Surprises Act provisions. It will include a federal portal for organizations to apply to become certified independent dispute resolution entities and for providers and payers to participate in the federal independent dispute resolution process: https://www.cms.gov/nosurprises/Help-resolve-payment-disputes.
Clink Here for the CMS: Complete Fact Sheet
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Lorraine Molinari
Queen Bee of Medicare
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