Feds set No Surprises Act administration fee at $115

The federal government issued a final rule Dec. 18 setting the fee to enter the No Surprises Act arbitration process at $115. 

The final rule also states that the administrative fee amount will be established no more than once per calendar year, according to a Dec. 18 CMS fact sheet. A separate proposal that would adjust fees for disputes initiated after Jan. 1, 2025, is open for comment until Jan. 2, 2024. 

The final rule comes after a Texas federal judge in August struck down a $350 fee federal departments initially had in place for 2023. The Texas Medical Association successfully argued that the fee hike restricted many physicians' ability to seek arbitration when an insurer offers insufficient payment for care. The lawsuit came after federal agencies announced in October 2022 that the administrative fees would remain $50 in 2023. Two months later, the agencies announced the fee would increase to $350 beginning in January 2023 "due to supplemental data analysis and increasing expenditures in carrying out the federal IDR process since the development of the prior 2023 guidance."  

The federal departments are also finalizing separate fees charged by IDR entities, payable by the losing side in a dispute. The fee range for single cases will be $200 to $840. For batched disputes, the fee range is $268 to $1,173. For batched disputes that exceed 25 line items, IDR entities can set a fixed fee in the range of $75-250 for each increment of 25 line items included in the request.  

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