An article in the June 25 issue of Part B News, “Heads up: New No Surprises rule may
block some IDR claims,” discussed the No Surprises Act’s recently effective final rule. Rivkin Radler’s Chris Kutner was quoted in the article.
The final rule affects how healthcare providers file independent dispute resolution (IDR) requests. Providers file the requests when health insurers exempt patients from paying fees that shouldn’t have been charged to them.
Chris noted that before the final rule took effect, the IDR process was highly inefficient. “In cases thus far filed through the IDR process, roughly 40% turn out to be ineligible,” he said. “So they shouldn’t have gone through the IDR process in the first place. There needs to be a better screening mechanism.”
Despite the final rule, Chris thinks there is still room for improvement. “Providers likely do not understand the nuances of what claims are eligible based on the coverage involved and will just file all of their claims and see what claims get adjudicated, and in some cases the awards are quite substantial,” Kutner says. “Providers may be faulted for the amounts being billed for services including complicated surgeries performed on an emergent basis, but they’re reacting to payers that offer them insulting low amounts.”
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