Premier submitted comments to the administration on the Surprise Billing Part 2 interim final rule (IFR). The IFR implements the consumer protections and dispute resolution process for out-of-network payment amounts as required by the Consolidated Appropriations Act of 2021.
The IFR establishes the federal independent dispute resolution (IDR) process that out-of-network providers, facilities, providers, plans, and issuers may use to determine the out-of-network rates in the event that an agreement cannot be reached in open negotiation. The IFR also establishes a patient-provider dispute resolution process for uninsured or self-pay patients. While Premier generally supports the provisions of the IFR, there are several key areas where the Departments could improve the regulations and their implementation:
- Align with previous guidance that initial payment amounts are intended to be payment in full by allowing only providers or facilities to initiate open negotiation periods and the federal IDR process
- Eliminate the presumption that the qualifying payment amount (QPA) is the correct or default payment about and instead instruct certified IDR entities to consider multiple factors, per Congressional intent
- Allow additional flexibility in required timelines for providing good faith estimates to uninsured and self-pay patients, particularly when a patient has not requested one
- Provide additional guidance to facilities, providers, and payers as they navigate a complex landscape of state and federal requirements