IDR Operations Rule Improves Process but Still Needs Enforcement Mechanism

ACEP applauds the Independent Dispute Resolution (IDR) Operations final rule released May 28 that will greatly strengthen the federal process that financially protects patients who receive care out of network and ensures a more effective pathway to fair reimbursement for physicians when insurers won’t include them as part of their in-network panel. However, strong enforcement will be necessary to hold insurance companies accountable for noncompliance.

“Finalizing these long-awaited reforms largely as proposed is an important step toward a more transparent, efficient, and effective IDR process, but it is only the first step,” said ACEP President L. Anthony Cirillo, MD, FACEP. “The rule’s overall success will now depend on strong, consistent enforcement and meaningful consequences for noncompliance.”

This final rule will reduce unnecessary disputes and speed up determinations by requiring insurers to provide all information needed for claims to be processed correctly. It also encourages meaningful negotiation so that IDR is used only as a last resort, while a modernized open negotiation workflow will significantly reduce administrative burden — creating efficiencies for physicians, insurers, and the government alike, and ultimately lowering health care costs for all.

ACEP looks forward to continuing work with the Trump administration and Congress to ensure that the No Surprises Act fulfills its promise to protect patients while facilitating fair and timely resolution of payment disputes.