The Departments of Health and Human Services (HHS), Labor, and Treasury (the Departments) released a proposed rule on the No Surprises Act’s (NSA) federal independent dispute resolution (IDR) process to allow providers, facilities, and health plans to resolve payment disputes for certain out-of-network charges.
The No Surprises Act prohibits providers from charging patients more for out-of-network emergency services, or for services performed by an out-of-network physician at an in-network facility. The proposed rule would require payers to provide additional information at the time of initial payment or notice of denial of payment and to use standardized codes to communicate whether a claim for an item or service furnished by an out-of-network provider or facility is or is not subject to the NSA’s surprise billing provisions and the federal IDR process. The proposed rule also outlines additional parameters for the IDR process itself and a process whereby qualified IDR items and services would be batched in order to address the unique circumstances of certain medical specialties and provider types.
The proposed rule has a 60-day public comment period.
Recent Posts
Medicaid in Focus: What Audiologists Need to Know Now
With the recent changes to Medicaid, the Academy is preparing audiologists with the new one-pager, “Audiology in Medicaid”, an exclusive member resource designed to educate on…
American Academy of Audiology Clinical Consensus Statement: Assessment of Vestibular Function in the Pediatric Population
Authors: Violette Lavender, AuD, Kristen Janky, PhD, Katheryn Bachmann, PhD, Melissa Caine, AuD, Micheal Castiglione, AuD, Guangwei Zhou, ScD The American Academy of Audiology Clinical…
CMS Releases CY 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Proposed Rule
On July 15, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule,…