Final NSA rule widens radiology IDR batching

Federal agencies have finalized changes to the No Surprises Act independent dispute resolution process, including provisions that affect how radiology payment disputes can be batched. CMS released the Federal Independent Dispute Resolution Operations final rule on May 28.

The rule was issued by the departments of Health and Human Services, Labor, and Treasury, along with the Office of Personnel Management. CMS said the changes are intended to streamline communication between payers, providers, and certified IDR entities, while clarifying timelines and processes.

Administrative fees will fall from $115 to $15 per party per dispute. CMS said the lower amount will apply to disputes initiated on or after 5 business days after publication of the final rule.

Batching rules also change. Qualified IDR items and services may be batched in several circumstances, including radiology, anesthesiology, pathology, and laboratory services furnished to 1 or more patients under service codes in the same Category I CPT code section, as specified in federal guidance.

A 50-line-item cap will apply to batched determinations. CMS said the limit is intended to help certified IDR entities make timely eligibility and payment determinations and forecast their costs.

Payers will also be required to use specific claim adjustment reason codes and remittance advice remark codes when communicating whether a claim is subject to No Surprises Act protections and the federal IDR process. CMS said the change is intended to reduce ineligible disputes.

Open negotiation will move into the federal IDR portal. Parties will be required to submit an open negotiation notice through the portal, and the 30-business-day negotiation period will begin when the notice and payment remittance or denial notice are submitted to the other party and federal departments.

Eligibility determinations will have a 5-business-day deadline after final certified IDR entity selection. Parties also must provide requested information within 5 business days or risk having the dispute proceed without that information or be closed.

The rule also creates an IDR Registry for payers subject to the federal process. CMS said the registry is meant to help providers identify the correct payer, distinguish between plans, and reduce information-sharing delays.

ACR said it was pleased the agencies addressed imaging-provider concerns. The college highlighted expanded dispute bundling, the reduced administrative fee, and requirements for insurers to provide necessary information with initial payments.

MGMA also backed parts of the rule, saying the lower administrative fee removes a barrier to IDR access, especially for smaller practices. The group said payer requirements to identify whether claims are subject to IDR should help reduce costly ineligible submissions.

Emergency physicians said the rule improves the IDR process but warned that enforcement remains unresolved. “The rule’s overall success will now depend on strong, consistent enforcement,” ACEP President L. Anthony Cirillo, MD, said in a statement.

CMS said the federal IDR process has received more than 5M disputes since launching in April 2022, far above expectations. The agency said the new rule is intended to reduce bottlenecks, ineligible disputes, and administrative costs.