CMS Notice: Payment Disputes Between Providers and Health Plans (Feb. 24, 2023)
HHS has resumed processing some, but not all, of the surprise billing independent dispute resolution (IDR) determinations that were recently suspended in response to a federal trial court decision vacating a portion of the final IDR regulations (see our Checkpoint article). Earlier this month, HHS’s Centers for Medicare & Medicaid Services (CMS) directed certified IDR entities not to issue new payment determinations until the agencies provide further guidance (see our Checkpoint article). In addition, any payment determinations issued after February 6, 2023 (the date of the court order), were to be recalled. CMS also explained that the agencies were in the process of evaluating and updating the federal IDR process guidance, systems, and related documents to make them consistent with the court order. CMS has now announced that certified IDR entities have been instructed to resume processing payment determinations beginning February 27, 2023, for disputes involving items or services furnished before October 25, 2022, since these items and services are not affected by the court order. Certified IDR entities are to continue to hold payment determinations involving items or services furnished on or after October 25 until the agencies issue further guidance.
EBIA Comment: The CMS notice advises that disputing parties should continue to engage in all other aspects of the federal IDR process, including submitting fees and offers. The agencies are working to complete guidance and system updates to reflect the February 6th court order while simultaneously battling a backlog of disputes (see our Checkpoint article). For more information, see EBIA’s Health Care Reform manual at Section XII.B.3 (“Surprise Medical Billing: Emergency and Non-Emergency Services.” See also EBIA’s Group Health Plan Mandates manual at Section XIII.B (“Patient Protections”) and EBIA’s Self-Insured Health Plans manual at Section XIII.C (“Federally Mandated Benefits”).
Contributing Editors: EBIA Staff.