US HHS finalizes rule to streamline dispute resolution under No Surprises Act

May 28 (Reuters) - The U.S. ‌Department of Health ​and ​Human Services (HHS) on Thursday finalized a rule to streamline how out-of-network payment disputes between providers and health insurers are resolved, ‌aiming to cut administrative costs.

Here are a few details:

• The ⁠rule, part of a federal law banning surprise medical bills from providers outside patients' ‌insurance networks, aims to ‌reduce ineligible disputes and lowering costs for providers and payers.

• "The No Surprises Act protects patients from unexpected medical bills while creating an arbitration ​process to resolve certain types of payment disputes between payers and providers, and this rule makes significant improvements to the arbitration," said ⁠Centers for Medicare & Medicaid Services Administrator Mehmet Oz.

• The arbitration happens through the Federal Independent Dispute ​Resolution process, which the provider or insurer can initiate if they cannot agree on a payment amount for the ​out-of-network care.

• The final rule aims ‌to cut administrative fee from $115 to $15 per party per dispute, potentially increasing participation, the agency said.

• It also increases ⁠flexibility in resolving a reasonable number of claims together in a single batch, reducing costs while speeding up decisions, HHS said.

• The rule also requires payers ⁠to use standardized claim codes when communicating about out-of-network services, helping providers determine early ​whether a claim qualifies for the IDR process, reducing ineligible disputes, HHS said.

• Under the rule, a new centralized platform to manage disputes would launch in phases ‌beginning this year.

• The No Surprises Act was passed in 2020 to protect patients from surprise billing, which ‌often arose when patients visited a hospital that was part of their ⁠insurance network, but later received ‌a bill from doctors ​who are not part of the same insurance network as the hospital.

(Reporting by Mariam Sunny in Bengaluru; Editing by ‌Joyjeet Das)

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