New Surprise Billing Rule Seeks to Smooth Arbitration Process

The Biden administration on Oct. 27 released a new proposed rule governing the troubled balance billing arbitration process established as part of the No Surprises Act (NSA), the 2021 law that banned surprise medical billing. Professional and trade groups for providers, which have filed legal challenges to previous rulemaking governing the arbitration process — called Independent Dispute Resolution (IDR) — declined to say whether they would challenge the proposed rule if implemented in its current form, but at least one legal expert thinks that the rule has a good chance of lasting.

The NSA forced payers and providers to hold patients harmless, from a medical-billing perspective, when they inadvertently seek out-of-network care. Thus, the law set up the IDR process to resolve payment disputes that payers and providers are now responsible for settling themselves instead of balance-billing patients.

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Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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