Government Releases Final Rule for Independent Dispute Resolution, Surprise Billing

All Markets

Sept. 7, 2022

On Aug. 19, the Biden administration released “Requirements Related to Surprise Billing: Final Rules". These rules finalize certain provisions of the No Surprises Act, which was enacted as part of the Consolidated Appropriations Act of 2021 (CAA). 
 
Things to know:

  • Certified independent dispute resolution (IDR) entities must first consider the Qualifying Payment Amount (QPA), and then all additional permissible information submitted by each party to decide which offer best reflects the appropriate out-of-network rate. 

  • Insurers will be required to submit additional information to the provider, facility, or air ambulance service provider about the QPA when they downcode a billed claim. 

  • The rules of air ambulance IDR determinations now largely mirror those for other providers and facilities. 

More information, including a fact sheet, FAQs and process status update, is available on the Department of Labor’s website.

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