CMS directs payment determinations to resume under No Surprises Act

2020 02 27 23 28 4046 Doctor Cancer Patient 400

The U.S. Centers for Medicare and Medicaid Services (CMS) has instructed independent dispute resolution (IDR) entities to resume payment determinations called for under the No Surprises Act.

Effective March 17, IDRs received the nod to resume issuing payment determinations for applicable out-of-network items or services furnished on or after October 25, 2022. The CMS had paused independent dispute resolution payment determinations on February 6 following a decision by the U.S. District Court for the Eastern District of Texas in a lawsuit filed by the Texas Medical Association.

The guidance issued March 17 now instructs IDRs to consider both the qualifying payment amount and additional information relating to the offers submitted by the parties. In addition, the new guidelines instruct certified IDRs to provide an explanation of the rationale for its decision, including what information was used to select the offer that best represents the value of the qualified IDR item or service. The weight given to the qualifying payment amount and any additional information submitted must be provided as part of the explanation.

The ACR noted that it and two other organizations urged the resumption of all IDR payment determinations, including those for items or services furnished on or after October 25, in a recent joint letter to CMS.

Page 1 of 3427
Next Page