Federal departments are seeking to raise the administrative fee to enter the No Surprises Act arbitration process from $50 to $150 in 2024.
The $150 fee is intended to cover the federal government's costs based on projections that 225,000 disputes will go through the independent dispute resolution process per year, according to the Sept. 21 proposal from HHS, the Labor Department and the Treasury Department.
Though the proposal would be a 200 percent increase over the current fee, it is lower than the $350 fee departments initially had in place for 2023. The $350 fee — a 600 percent increase over the previous year — was successfully challenged in a lawsuit by the Texas Medical Association.
The TMA 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 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."
A Texas federal judge in August ruled that the federal departments did not follow notice and comment requirements when hiking administrative fees. Following that ruling, the IDR fee was lowered to $50 for the remainder of the year.
A separate fee charged by IDR entities, payable by the losing side in a dispute, would be $200 to $840 for single cases in 2024, representing a 20 percent increase at the upper range. For batched disputes, the fee range would be $268 to $1,173, a 25 percent increase at the upper range.
The proposed rule, if finalized, would take effect Jan. 1, 2024.