Michigan IDR Arbitration For Medical Revenue Recovery

Michigan Surprise Billing Law (SBL)

The Michigan Surprise Billing Law, effective October 22, 2020, is governed by MCL 333.24501 to MCL 333.24517 of the Michigan Public Health Code. It establishes reimbursement frameworks and provides mechanisms for dispute resolution.

Key Provisions

1. Reimbursement Rates:
   • Reimbursement is tied to percentages of in-network (INN) rates and Medicare rates, which vary depending on:
     • The type of provider.
     • The circumstances of the claim.
2. Arbitration Process:
   • Providers can seek a 25% increase in reimbursement if complicating factors exist and are presented in arbitration.

Federal and State Coordination

1. State Enforcement:
   • The Michigan Department of Insurance and Financial Services (DIFS) enforces:
     • Sections 2719, as applied by Section 110 of the No Surprises Act.
     • Sections 2746, excluding 2746(c).
     • Sections 2799A-1 through 2799A-5.
     • Section 2799A-9, excluding 2799A-9(a)(4).
   • The Michigan Department of Licensing and Regulatory Affairs (LARA) enforces:
     • Section 2799B-1 of the Public Health Service (PHS) Act, specifically regarding health care providers.
2. Federal Independent Dispute Resolution (IDR) Process:
   • Federal IDR applies where state provisions do not determine reimbursement or where disputes involve nonparticipating providers, nonparticipating emergency facilities, or air ambulance services not explicitly covered under Michigan’s law.

This structure ensures collaboration between state and federal entities in resolving OON billing disputes, as highlighted in a letter from CMS to the Governor of Michigan, dated December 27, 2021.