Skip to content
English
Contact Us
  • There are no suggestions because the search field is empty.

Proposed Federal Rules Changes for 2025: What to Know

The implementation of the No Surprises Act (NSA), which protects patients from unexpected bills from out-of-network providers, is an ongoing process. With new Federal rules projected to take effect in 2025, it’s important for providers and payers to prepare now for changes in the dispute resolution process.

The proposed rules aim to speed up the IDR process, but there are steps you can take now to expedite your own procedures. Let’s look at some of the ongoing challenges and how the Departments propose to address them. By preparing ahead of time, payers and providers can ensure compliance with the new regulations and streamline their operations.

Change #1 - Additional Information Sharing

Payers and providers experience challenges in communication and obtaining needed information for resolving payment disputes. The new proposal requires payers to provide additional details during initial payment or denial notices, including:

  • The legal business name of the plan or issuer
  • The plan sponsor's name, if applicable
  • The IDR registration number

FHAS Pre-Rule Recommendations:

  • Direct Open Negotiation and Initiation: Make sure to direct your open negotiation and initiation requests to the correct email address. If you don’t find it on the EOB, do your best to obtain it. If you're struggling to get the right contact, don’t hesitate to reach out to FHAS for assistance.
  • Obtain Necessary Contact Information: It’s crucial to get the correct contact information to avoid disputes being closed without the chance for resubmission. Accurate details will help ensure that your disputes are processed without unnecessary delays.

Change #2 - New Open Negotiation Requirements

To facilitate a more clear information exchange between parties during the Federal IDR process, the Departments propose the following changes:

  • Requirement for Parties to Provide an Open Negotiation Notice: Parties must submit an open negotiation notice to each other and the Departments via the Federal IDR portal to initiate the 30-business-day negotiation period.
  • Inclusion of New Required Content in the Notice: The notice must include new elements to clarify the item or service, reasons for denial or initial payment, and whether the Federal IDR process applies.
  • Introduction of an Open Negotiation Response Notice: The receiving party must provide an open negotiation response notice to the other party and the Departments by the 15th business day of the negotiation period.

FHAS Pre-Rule Recommendations:

  • Upload "Proof of Delivery": Ensure you upload "proof of delivery" for both the initiation and open negotiation notices sent to the initiating party. This step will help to expedite the process by addressing any objections related to not receiving the open negotiation.

By providing proof of delivery, you can reduce delays and prevent payment disputes from being hindered by issues related to notification receipt. 

Change #3 - New Batching Provisions

The Departments propose the following when qualified IDR items and services relate to treatment of a similar condition:

  • Allowing Certain Qualified IDR Items and Services to Be Batched: Certain items and services that meet specific criteria can be grouped together for processing.
  • Limiting Batched Determinations to 25 Qualified IDR Items and Services per Dispute: The number of items and services that can be batched per dispute will be capped at 25.

FHAS Pre-Rule Recommendations:

  • Follow Each Entity's Batching Policies: Until the new guidelines are implemented, follow the existing batching policies of each entity. This will help ensure consistency and adherence to current procedures. Here are FHAS’ batching guidelines.
  • Note Similarities and Differences with FHAS Current Policies: While the proposed changes align closely with our current batching practices, the key difference is the limit per dispute. FHAS does not include a 25 line item limit. 

Change #4 - New Eligibility Determinations

The Departments believe that the main reason for delays in processing disputes is the difficulty in deciding if disputes qualify for the Federal IDR process. The No Surprises Act doesn't set a deadline for determining this eligibility. The proposed changes are:

  • Certified IDR Entities to Determine Eligibility Within Five Business Days: Certified IDR entities will be required to make eligibility determinations within five business days of their final selection.
  • Requirement for Parties to Submit Additional Information Within Five Business Days: Parties must provide any requested additional information within five business days.

FHAS Pre-Rule Recommendations:

  • Timely Information Submission: Ensuring that parties submit requested information promptly is crucial for meeting the new deadlines and facilitating a smooth and efficient IDR process.

FHAS remains dedicated to making eligibility decisions as swiftly as possible, aiming to align with or exceed the new timelines. With more than 200K+ (and counting) IDR disputes closed, FHAS has a reputation across the country for quality, consistency, and timely results.

Change # 5 - Direct Administrative Fee Collection

To streamline the collection of administrative fees during the dispute resolution process, the Departments propose the following changes:

  • Direct Collection of Non-Refundable Administrative Fees: Fees will be collected directly from the disputing parties rather than through certified IDR entities.
  • Specific Payment Timelines: The initiating party must pay within two business days of preliminary IDR entity selection, and the non-initiating party within two business days of receiving the eligibility determination notice.

FHAS Recommendation:

  • Make Current Admin Fee Payments: Continue to make administrative fee payments to entities as currently required.
  • Prepare for Potential Timeline Changes: Be ready for a potential reduction in payment timelines from 10 business days to 2 business days. It's important to make sure your facility can handle this change.

Change #6 Extending Time Periods Due to Extenuating Circumstances

The Departments also propose changing the special circumstances under which they can extend the time periods.

  • Amend Criteria for Extending Time Periods: Adjust the criteria for extending time periods in the Federal IDR process to better handle extenuating circumstances, such as unexpected high numbers of disputes or problems with the Federal IDR portal system.
  • Public Notice for Systematic Delays: The Departments will issue public notices for any systematic delays affecting the process.
  • Continued Allowance for Extensions: Parties can still request extensions for extenuating circumstances through the Federal IDR portal.

FHAS Recommendation:

Preparing for Change with FHAS: Your Roadmap to Compliance 

As we approach the 2025 deadline for the new Federal IDR process rules, FHAS wants payers and providers to be ready. We are committed to supporting all parties throughout this transition, offering needed guidance and clarification on the proposed rules. Stay informed with FHAS for the latest updates and don’t hesitate to reach out for assistance to navigate these changes effectively.

 

    Legal Disclaimer

    The information contained in this content piece is for general informational purposes only. While we strive to ensure the accuracy and completeness of the information presented, we make no representations or warranties of any kind, express or implied, about the accuracy, reliability, suitability, or availability with respect to the content or the information, products, services, or related graphics contained in the content piece for any purpose. Any reliance you place on such information is therefore strictly at your own risk. The content of this white paper is subject to change without notice. The information provided in this document does not constitute legal or other professional advice, and is non-binding upon FHAS and any federal government agencies.