CMS fully resumes dispute resolutions under No Surprises Act following pressure from radiologists
CMS has resumed the process, spelled out in the No Surprises Act, for resolving out-of-network payment disputes between providers and insurers, a move praised by radiologists and other docs.
The federal government had partially halted this key activity in February in response to a Texas judge’s order, decreeing that portions of the framework violate federal rules. Physician groups including the American College of Radiology have since pressured the feds to resume this process and address a growing stack of unresolved cases, and CMS has now obliged.
With the March 17 relaunch, the agency has revised its guidance for independent dispute resolution, taking into account the Feb. 6 court order. This includes stipulating that arbiters must take into account all evidence presented by both parties, and not weigh the “qualifying payment amount” more heavily.
“At last, the guidance seems to closely reflect what the No Surprises Act statute actually says,” the American College of Emergency Physicians, which has pushed for the resumption alongside the ACR, said in an announcement. “This is a major advancement in ACEP's advocacy push to make the arbitration process more fair and balanced … Hopefully now since the IDR process is reopened, arbiters can start working through the significant backlog.”
CMS previously instructed arbiters to resume dispute resolutions at the end of February. But that applied only to services furnished before Oct. 25, which were not impacted by the Texas judge’s order. ACR, ACEP and the American Society of Anesthesiologists sent a letter to the Center for Consumer Information and Insurance Oversight last month, urging officials to address cases that have accumulated since October.
“The letter stated that delays in payment determinations were exacerbating the existing IDR backlogs and harming members’ practices by holding up payments for services provided to patients,” ACR said in a Tuesday, March 21, news update announcing the resumption.
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.