CMS instructs IDR entities to resume all payment determinations

CMS authorized independent dispute resolution (IDR) entities to resume payment determinations for disputes involving items or services furnished on or after October 25, 2022.

On February 27, CMS gave the same authorization for disputes furnished prior to October 25, 2022. The agency previously halted all payment determinations after a U.S. District Court ruling that said the revised IDR process violated the No Surprises Act and favored commercial insurers.

In addition to these authorizations, CMS released updated guidance for disputing parties and certified IDR entities.

“The departments have completed the necessary updates to the federal IDR portal and federal IDR process guidance documents to reflect these revised payment determination standards,” said CMS.

Starting March 17, disputing parties should expect to receive the majority of payment determination notices from auto-reply-federalidrquestions@cms.hhs.gov, according to CMS.

The agency said it may release additional guidance on the IDR process in the future.

Revenue integrity professionals must ensure their organization is in compliance with the No Surprises Act. If it’s necessary to initiate a dispute through the federal IDR process, ensure the item or service is eligible and the submission is complete. Review the updated guidance for disputing parties and make any necessary changes.

Editor's note: Find more NAHRI resources on the No Surprises Act here.