CMS kick-starts key piece of IDR process under surprise billing law
The Centers for Medicare & Medicaid Services has instructed independent dispute-resolution entities to resume eligibility determinations under the No Surprises Act, although the actual IDR process remains on hold.
CMS announced the resumption on Tuesday, noting that it pertains to single and bundled payment disputes submitted on or before Aug. 3. The move comes after the agency recently suspended the IDR process in response to an Aug. 3 court decision, vacating the 600% increase in the fee radiologists and other providers must pay for each dispute.
“All other aspects of Federal IDR process operations remain suspended,” the Centers for Medicare & Medicaid Services said in its Sept. 5 announcement. “Disputing parties may continue to engage in open negotiation.”
The American College of Radiology highlighted the CMS’ announcement in a Thursday news update, noting that the move “simply means that IDR entities may verify that submitted disputes meet the criteria for being eligible for IDR.” ACR said the resumption in eligibility determinations came in “response to provider calls” for the agency to end the monthlong pause in the IDR process.
The Texas Medical Association has filed multiple lawsuits, challenging the feds’ implementation of the legislation and leading to the current pause in the process.
“These TMA rulings do not impact the patient protections included in the NSA that the American College of Radiology advocated for and continues to fully support, nor does it raise patient out-of-pocket costs,” the college said Sept. 7.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.