CMS Says All Payment Determinations Under No Surprises Act Must Resume

Organizations will soon be seeing their IDR payment determinations.

CMS just announced that certified independent dispute resolution (IDR) entities must resume making payment determinations for disputes involving items or services furnished on or after October 25, 2022.

In the same announcement, CMS said that starting last week, disputing parties will begin receiving a majority of their payment determination notices from the IDR portal.

CMS’ announcement comes on the heels of demands by medical associations for CMS to resume all disputed No Surprises Act payment determinations.

At the time, the American College of Emergency Physicians, the American College of Radiology, and the American Society of Anesthesiologists urged CMS to quickly resume all IDR payment determinations paused by its February order.

Following a court decision that vacated nationwide the federal government’s revised IDR process, in early February CMS instructed certified IDR entities to hold all payment determinations until the departments issued further guidance.

While CMS provided some relief at the end of February when it instructed certified IDR entities to resume making determinations for payment disputes involving services provided before October 25, the associations called on the agency to resume swift determinations for disputes after that date too.