The Internal Revenue Service, Employee Benefits Security Administration, and the Centers for Medicare & Medicaid Services (collectively, “the Departments”) recently issued final rules concerning fees established by the No Surprises Act for the federal Independent Dispute Resolution (IDR) process. The Departments issued these rules through a notice and comment rulemaking process after a federal court overturned portions of the previous guidance that they had previously issued to establish the administrative fee amounts for the federal IDR process beginning January 1, 2023.

The final rules provide for an administrative fee charged by these agencies to participate in the IDR process and the methodology for determining that fee. Likewise, the rules determine the certified entity IDR fees range for single and batched determinations. The rules also finalize the number of administrative fees and certified entity IDR fee ranges for disputes on or after the effective dates of the rules. The final rules went into effect on January 22, 2024.

Administrative Fees to Participate in the IDR Process

Under the final rules, the administrative fee for disputes initiated on or after January 22, 2024, is $115 per party, an increase from the previous fee of $50 per party per dispute. The Departments will set the amount of this fee through notice and comment rulemaking once per calendar year at most. Furthermore, the Departments may set the fee amount less frequently than annually if the estimated total amount of administrative fees paid under the currently set amount would continue to equal the estimated expenditures for the federal IDR process for the upcoming calendar year.

In terms of methodology, the Departments will use the estimated number of administrative fees paid to certified IDR entities to estimate the total number of administrative fees paid. The Departments also estimate the expenditures of the federal IDR program to be approximately $56.6 million. As a result of these changes to the proposed rules, the overall administrative fee for disputes is lower than the originally proposed $150 per party administrative fee.

The Range of Certified Entity IDR Fees for Single and Batched Determinations

Before these rules, the range of certified entity IDR fees for single and batched disputes was set through guidance published annually by the Departments. Under the final rules, these fee ranges will be set through notice and comment rulemaking, at most annually.

Certified IDR entities must provide separate fixed fees for single determinations and batched determinations within the permissible upper and lower limits set by the Departments annually through the notice and comment rulemaking process. However, these entities may request approval from the Departments to update their fees one additional time per year.

For disputes initiated on or after January 22, 2024, certified IDR entities can charge a fixed certified IDR entity fee for single determinations within the range of $200 to $840 and for batched determinations within the range of $268 to $1,173. These entities can charge a fixed tiered fee of $75 to $250 for every twenty-five line items within a batched dispute beginning with the twenty-sixth line item. However, these entities can charge a fee outside these ranges if the Departments have approved the fee through an existing written process.