December 15, 2023

Federal Government Resumes Independent Dispute Resolution for Batched Claims

The Centers for Medicare and Medicaid Services (CMS) announced Dec. 15 that the portal for providers and insurers to file payment disagreements related to the No Surprises Act (NSA) is again open for the initiation of new batched claim disputes. CMS temporarily suspended the independent dispute resolution (IDR) process Aug. 3, following the U.S. District Court for the Eastern District of Texas’ decision in the lawsuit known as Texas Medical Association (TMA) IV; that decision vacated regulations related to batching provisions and the administrative fee that must be paid to file a disputed claim. The portal was reopened for single claims Oct. 6.

The American College of Radiology® (ACR®) strongly opposed the extended pause of the IDR process for batched claims, as many imaging claims eligible for dispute are less than the current $50 administrative fee required to be paid to initiate the process. While the College is pleased that the federal IDR portal is now completely reopened, there are significant concerns with the 20 business-day extension allowed for claims where the initiation deadline fell on any date between Aug. 3, 2023, and Dec.15, 2023. Parties only have until Jan. 16, 2024, to initiate batched disputes that have been on hold since August.

When the federal IDR portal reopened for single claim disputes in October, a 20 business-day extension was provided and was not enough time for stakeholders to submit disputes for claims that were on hold for more than two months. Batched claim disputes were on hold for twice as long and are being held to the same 20 business-day extension, occurring during the winter holiday season. The ACR is working with the American College of Emergency Physicians and the American Society of Anesthesiologists to communicate with CMS that additional time is needed.

For more information or if you have questions, contact Katie Keysor, ACR Senior Director of Economic Policy.