IDRs resume all payment determinations under No Surprises Act

The Centers for Medicare & Medicaid Services today instructed certified independent dispute resolution entities to resume making payment determinations for disputes involving items or services furnished on or after Oct. 25, 2022. Updated guidance to disputing parties regarding disputes involving items and services furnished on or after Oct. 25, 2022 is posted here. CMS also announced that starting March 17, disputing parties will begin receiving a majority of their payment determination notices from the IDR portal, specifically from auto-reply-federalidrquestions@cms.hhs.gov. Disputing parties are advised to make note of this email address. 

Following a court decision that vacated nationwide the federal government’s revised IDR process, CMS on Feb. 10 instructed certified IDR entities to hold all payment determinations until the departments issued further guidance. On Feb. 27, certified IDR entities resumed issuing payment determinations for payment disputes involving out-of-network services and items furnished before Oct. 25, 2022.

A Texas judge on Feb. 6 held that the revised IDR process skews the arbitration results in commercial insurers’ favor in violation of the compromise Congress reached in the Act. As a result of this decision, the regulations are vacated nationwide.