Changes to the No Surprises Act aim to streamline the payment dispute process for providers, including durable medical equipment (DME) suppliers, working with group health plans and health insurance providers.
The Centers for Medicare & Medicaid Services (CMS) announced the changes on May 28, in partnership with the Department of Labor, the Department of the Treasury, and the Office of Personnel Management. CMS said the new rule “directly addresses bottlenecks by helping to reduce the number of ineligible disputes entering the system at a lower cost to payers and providers.”
The new rule reduces the administrative fee per party and per dispute from $115 to $15, “lowering barriers to participation while maintaining a self-sustaining program,” CMS added. “The rule also allows more flexibility for claims to be resolved together in one batched dispute, reducing costs, while simultaneously speeding up decisions by placing reasonable limits on the number of claims per batched dispute.”
The announcement said the federal Independent Dispute Resolution (IDR) system has received more than 5 million disputes since its introduction in April 2022, “far exceeding expectations and creating delays and unnecessary costs.”
“Americans should never be blindsided by unexpected medical bills,” said Department of Health & Human Services Secretary Robert F. Kennedy Jr. in the announcement. “This rule cuts through bureaucratic delays, strengthens transparency between payers and providers, while continuing to protect patients from unnecessary financial stress.”
“Today, the Trump Administration is taking an important step to strengthen the federal Independent Dispute Resolution process and ensure it works as Congress intended under the No Surprises Act,” said Acting Secretary of Labor Keith Sonderling. “By improving transparency, streamlining dispute review, and ensuring consistent communication standards, we are helping all parties obtain timely, fair payment determinations while reducing administrative burdens. Most importantly, these improvements support the continued protection of patients from surprise medical bills and reinforce our commitment to a simpler, more reliable health care system.”
A new IDR gateway, whose launch will begin this year, will act as a centralized system that enables users to start disputes, track their status, and manage activity.
“Eventually, the IDR Gateway will be used to require payers to register, making it easier for providers to identify the correct party, reduce errors and avoid unnecessary disputes,” the announcement said. “Other additional features, including in-portal negotiation, will roll out over time to improve accountability and reduce unnecessary filings.
CMS also released a fact sheet about the IDR operations final rule.
