Physician groups pair IDR praise with enforcement warning

Three physician societies have welcomed the final No Surprises Act independent dispute resolution rule while warning that enforcement remains necessary. The American College of Radiology, American Society of Anesthesiologists, and American College of Emergency Physicians issued a joint response after the federal rule was released May 28.

The groups said the rule addresses long-running barriers that have limited physician access to IDR. They cited a lower administrative fee, clearer timelines, stronger communication standards, and more defined open-negotiation expectations.

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

Administrative fees will drop to $15 per party per dispute. CMS said the reduced fee will apply to disputes initiated on or after 5 business days after publication of the final rule.

Transparency requirements were another point of support from the physician groups. CMS finalized requirements for payers to use specific claim adjustment reason codes and remittance advice remark codes to show whether a claim is subject to No Surprises Act protections and the federal IDR process.

Batching changes also affect radiology. CMS said radiology, anesthesiology, pathology, and laboratory services may be batched when they are furnished to 1 or more patients under service codes in the same Category I CPT code section, subject to federal guidance. A 50-line-item cap will apply to batched determinations.

“The final rule addresses persistent challenges that have kept physicians from effectively using the IDR,” ACR CEO Dana H. Smetherman, MD, MPH, MBA, FACR, said in the joint statement. She pointed to fee reduction and standardized CARC and RARC use as significant changes.

The societies said the rule does not end the work. They called for consistent enforcement and consequences for insurers that delay or withhold payment after physicians prevail in IDR.

ACR had separately said it was pleased federal departments addressed imaging-provider access concerns. The college highlighted expanded dispute bundling, lower administrative fees, and requirements for insurers to provide necessary information with initial payments.

The joint statement also said the 3 groups recently met with the White House Office of Management and Budget about No Surprises Act implementation. The societies said they will continue working together on implementation of the law.