CMS Places Hold on Surprise Billing Independent Dispute Resolution Decisions

The Centers for Medicare and Medicaid Services (CMS) instructed certified Independent Dispute Resolution (IDR) entities to hold off on making any decisions in determining payment for certain out-of-network services under the No Surprises Act. CMS’ action is the result of a Feb. 6 Texas federal court ruling vacating the federal government’s revised regulations on the IDR process.

The announcement stated “the Departments are in the process of evaluating and updating Federal IDR process guidance, systems, and related documents to make them consistent with the TMA II decision. Effective immediately, certified IDR entities should not issue new payment determinations until receiving further guidance from the Departments.”

The American College of Radiology® (ACR®) 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 and the 600% administrative fee increase for the IDR process announced in December. The College filed an amicus brief on the QPA lawsuit in late January and will support the most recent lawsuit on the administrative fee increase.

For more information, please contact Katie Keysor, ACR Senior Director, Economic Policy.