The Centers for Medicare & Medicaid Services (CMS) on March 17 updated its independent dispute resolution (IDR) process guidance to resume processing all payment determinations under the No Surprises Act rules.
Updated standards for IDR entities to evaluate payment disputes were applied to those services furnished on or after Oct. 25, 2022. The standards emanate from a ruling in an August 2022 case out of the U.S. District Court for the Eastern District of Texas. Previously, CMS instructed IDR entities to resume payment determinations only for those services furnished before Oct. 25, 2022. This most recent update now effectively applies to all payment determinations.
CMS writes that as of March 17, disputing parties will begin receiving most of their payment determinations on the IDR portal, specifically from firstname.lastname@example.org. More detailed IDR process guidance is available online for both IDR entities and disputing parties.