The rule finalizes tenets of the independent dispute resolution process — specifically negotiation and arbitration, according to a Nov. 4 post from Georgetown University professors Jack Hoadley and Kevin Lucia.
The duo argues that while the rule doesn’t determine how much is paid, it points arbitrators toward the median in-network rate to begin resolving payment disputes, which is often close to negotiated contract rates.
The new rule moves arbitrators away from using “usual and customary rates,” which often drive up premiums by issuing high payouts to providers, the professors wrote. By now using the qualifying payment amount, providers are less likely to seek arbitration.
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