As a result of the fourth ruling by the U.S. District Court for the Eastern District of Texas regarding the flawed implementation of the No Surprises Act (NSA), the government has once again announced a suspension of all federal independent dispute resolution (IDR) operations. The Centers for Medicare and Medicaid Services update indicates that disputing parties should continue to engage in open negotiations during the IDR pause.
In the lawsuit filed by the Texas Medical Association (TMA), known as “TMA III”, the court determined that the government was incorrectly permitting insurers to use a faulty methodology when calculating their median in-network rate, also known as the qualifying payment amount (QPA). As a result, new regulations on the QPA calculation and its impact on the IDR process will need to be created to comply with the court decision. As such, IDR entities have been instructed to cease all IDR decisions until further notice.
The IDR process has been suspended for initiation of new claims since the U.S. District Court for the Eastern District of Texas ruled in favor of the TMA, Texas Radiological Society, Houston Radiology Associated and others (dubbed “TMA IV”) that the government’s “fee increase and batching rule” implementing the NSA violated federal law on Aug. 3. The court ruled that the government’s “fee increase and batching rule” implementing the NSA violated federal law.
These TMA rulings do not impact the patient protections included in the NSA that the American College of Radiology® (ACR®) advocated for and continues to fully support, nor does it raise patient out-of-pocket costs.
For more information or if you have questions, contact Katie Keysor, ACR Senior Director of Economic Policy.