March 06, 2023

Medical associations call on CMS to resume all disputed No Surprises Act payment determinations

The American College of Emergency Physicians (ACEP), the American College of Radiology® (ACR®) and the American Society of Anesthesiologists (ASA) are urging the Centers for Medicare and Medicaid Services (CMS) to quickly resume all independent dispute resolution (IDR) payment determinations paused by its order on Feb. 6. While CMS provided some relief Feb. 24, when it instructed certified IDR entities to resume making determinations for payment disputes involving services furnished before Oct. 25, ACR, ACEP and ASA call on the agency to resume swift determinations for disputes involving items or services furnished on or after Oct. 25 as well.

CMS temporarily halted the IDR process payment determinations — included in the No Surprises Act passed into law in December 2021 — following a U.S. District Court for the Eastern District of Texas decision in the case of Texas Medical Association, et al., v. United States Department of Health and Human Services. The medical associations assert that the government’s pause exacerbates the existing backlog of IDR determinations, causing harm to healthcare providers who provided those services.

ACR, ACEP and ASA jointly supported the Texas Medical Association’s lawsuit by filing an amicus brief last October. Two additional lawsuits have been filed by the Texas Medical Association addressing the qualifying payment amount (QPA) calculation methodology, the 600% administrative fee increase for the IDR process announced in December and overly restrictive batching rules. ACR, ACEP and ASA filed amicus briefs on the QPA lawsuit in late January and the administrative fee increase and batching lawsuit in February.