Medicare Compliance & Reimbursement

Since its enactment in 2021, the No Surprises Act has come up against a plethora of legal disputes, causing the feds to tweak policies repeatedly. Read on for the latest on independent dispute resolutions (IDRs).

Reminder: After Congress laid out plans for the No Surprises Act (NSA) in the Consolidated Appropriations Act, 2021 (CAA), the Centers for Medicare & Medicaid Services (CMS) implemented the legislation via two interim final rules released in July and October of 2021 and a final rule in August 2022 (see Medicare Compliance & Reimbursement, Vol. 47, Nos. 14 & 21, Vol. 48, No. 19). Along the way and between rule releases, lawsuits and a plethora of changes have ensued related to the enforcement of the regulation and the requirements for both insurers and providers.

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First: On February 10, CMS instructed certified IDR entities to stop issuing new payment determinations. This latest change was based on a February 6 judgment by the U.S. District Court for the Eastern District of Texas that vacated parts of the NSA. Meanwhile, CMS also advised certified IDR entities to “continue working through other parts of the IDR process as they wait for additional direction from the Departments,” online guidance noted.

Next: Then in a confusing move, CMS partially re-upped the policy on February 24, allowing certified IDR entities to process payment determination, but only “for disputes involving items or services furnished before October 25, 2022,” the agency added.

Now: On March 17, IDR entities were directed that the restriction was lifted and to process all payment determinations, including disputes on or after October 25, 2022. Additionally, disputing parties should expect information to come through the IDR portal from now on, CMS said in the update.

Find a more in-depth breakdown of the IDR payment determination timeline at www.cms.gov/nosurprises/ help-resolve-payment-disputes/payment-disputes-between-providers-and-health-plans.