ACEP, ACR and ASA Applaud Final IDR Operations Rule as Major Step Forward for No Surprises Act Implementation

Key Takeaways:

• Important step forward: The long-awaited final rule better aligns the No Surprises Act with congressional intent, ensuring physicians have an unbiased process when insurers refuse to negotiate reasonable, market-based rates.
• Strengthens transparency: The final rule makes it easier for physicians to use the IDR process by lowering fees and improving transparency so they can better identify eligible claims for dispute resolution.
• Improves the IDR process: New timelines, communication standards, and expectations for good-faith involvement in the open negotiation period aim to make the system more predictable and efficient.

WASHINGTON, D.C. — The American Society of Anesthesiologists (ASA), American College of Emergency Physicians (ACEP) and American College of Radiology (ACR) today applauded the final Independent Dispute Resolution (IDR) Operations Rule under the No Surprises Act (NSA) released on May 28, commending federal agencies for their thoughtful and collaborative approach in addressing longstanding challenges and advancing a more functional, transparent dispute resolution system.

The groups emphasized that the final rule reflects many of the core reforms physician organizations have consistently sought to ensure a fair payment process that works for physicians and patients alike, while limiting opportunities for gaming by insurance companies.

“For more than two years, ASA has worked closely with federal agencies to improve the IDR process so that it functions as Congress intended,” said ASA President Patrick Giam, M.D., FASA. “We commend the Departments of Health and Human Services, Labor, and Treasury for their leadership and responsiveness in finalizing a rule that incorporates many of the meaningful policy changes physicians have been calling for.”

“The final rule addresses persistent challenges that have kept physicians from effectively using the IDR. Among the most significant improvements are the administrative fee reduction and strengthened transparency requirements, including use of standardized Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARCs), which can give physicians a clearer understanding of which claims are eligible for IDR and help reduce unnecessary disputes,” said ACR CEO Dana Smetherman, MD, MPH, MBA, FACR.

The rule also includes important reforms to the IDR process itself, such as clearer timelines, enhanced communication standards, and stronger expectations for good-faith engagement during open negotiations. These changes are expected to improve efficiency and ensure that all parties participate constructively in resolving payment disputes.

The organizations caution that while a significant milestone, finalizing the rule does not end the work. The reforms will only deliver on their promise if they are backed by rigorous, consistent enforcement and real consequences for insurance companies that fail to comply, particularly for those that delay or withhold payment after a physician prevails in the IDR process. These operational improvements must be paired with sustained oversight to ensure the system functions as Congress intended.

“Physicians need a dispute resolution system that is predictable, efficient, and grounded in transparency,” said ACEP President L. Anthony Cirillo, M.D., FACEP. “This final rule represents meaningful progress toward that goal and will help restore confidence in the process.”

The national organizations’ advocacy on this issue has been sustained and collaborative. Most recently, the groups met with the White House Office of Management and Budget (OMB) to underscore the urgency of finalizing the rule and the importance of a fully functioning IDR system. The societies continue to work closely with their partners to ensure the law is implemented effectively.

About the American Society of Anesthesiologists (ASA)
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 60,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve patient care. For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Follow ASA on Facebook, X, Instagram, Bluesky, and LinkedIn.

About the American College of Radiology (ACR)
The American College of Radiology (ACR), founded in 1924, is a 40,000-member medical association that advances patient care, radiological practice, and collaborative results through advocacy, quality standards, research, and education. ACR represents all of Radiology – including diagnostic and interventional radiologists, radiation oncologists, nuclear medicine/molecular imaging physicians, medical physicists, and other radiology professionals. www.acr.org.

About the American College of Emergency Physicians (ACEP)
The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education, and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million people they treat on an annual basis. For more information, visit www.acep.org and www.emergencyphysicians.org.

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