Looking to balance access and sustainability in the Federal Independent Dispute Resolution (IDR) To balance access and sustainability in the Federal Independent Dispute Resolution (IDR) process, the Proposed Operations Rule contemplates a significant series of changes throughout the process, including to the early communications and initiation process, open negotiations, and batching. In addition, the proposed rule includes many changes to the timing and remittance of administrative fees, as well as fee levels in certain situations.
The proposed rule, set forth by the federal Departments of Treasure, Labor and Health and Human Services (the departments), is now in its final federal review at the Office of Management and Budget.
Administrative Fees Today
Under today’s regulations, the administrative fee for the IDR process is $115. It is payable by both parties at the same time – typically about 10 days following the eligibility determination – and is nonrefundable. The fees are paid to the selected IDR entity (IDRE) which remits them to the Centers for Medicaid & Medicare Services (CMS) to support the IDR system.
The administrative fee is distinct from fees charged to both parties by the IDRE. IDRE fees vary by entity and are refunded to the winning party.
Changes Proposed for Both Parties to a Dispute
If approved as written in the proposed rule, disputing parties would be required to pay the administrative fee directly to CMS, “to streamline the collection of administrative fees.” In addition, payment timing would change, and the administrative fee amounts would vary, or be reduced, to “align financial incentives.”
The initiating party would be required to pay its fee within two business days of the preliminary selection of the IDRE. Failure to do so would trigger closure of the dispute for nonpayment, and neither party would owe the administrative fee.
The non-initiating party would be required to pay its administrative fee within two business days of receiving notice of an eligible dispute. If the party does not pay, its offer would not be considered as received. In addition, debt collection procedures would be established if the non-initiative party fails to pay in a timely manner.
Increasing Affordability and Access
To make the process more affordable, and thereby more accessible for smaller claims, the proposed rule also contemplates certain fee reductions. Reduced fees would apply:
- When the highest offer made during the open negotiation portion of the process – by either party – is less than a predetermined threshold.
- If the dispute is determined ineligible by either the IDRE or the Departments*, the non-initiating party would pay a reduced fee.
The proposed changes to administrative fees align with other proposed changes that are designed to discourage the filing of ineligible disputes.
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