Federal Government Grants Additional Time for Independent Dispute Resolution Submissions

The Centers for Medicare and Medicaid Services (CMS) announced Dec. 21 an additional 40 business-day extension for providers and insurers to file payment disagreements related to the No Surprises Act (NSA). The government previously announced on Dec. 15 that the federal independent dispute resolution (IDR) portal was reopened for submission of batched claim disputes that had been suspended since Aug. 3, allowing only 20 business days to submit held claims. The American College of Radiology® (ACR®), along with the American College of Emergency Physicians and the American Society of Anesthesiologists met with CMS staff this week to request additional time for practices to submit batched claims. CMS responded by granting a further extension until March 14.

The temporary suspension of the IDR process followed the U.S. District Court for the Eastern District of Texas’ decision in the lawsuit known as Texas Medical Association (TMA) IV that 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 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. 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 were initially held to the same 20 business-day extension, occurring during the winter holiday season. The College is pleased with the additional 40 business-day extension and thanks CMS for the swift action to allow more time.

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