The Centers for Medicare & Medicaid Services (CMS) announced that effective Feb. 27, certified independent dispute resolution (IDR) entities can resume issuing No Surprises Act payment determinations for payment disputes involving out-of-network services and items furnished before Oct. 25, 2022.
Issuance of payment determinations for items or services furnished on or after Oct. 25, 2022, will continue to be held until the Departments of Health and Human Services, Labor, and the Treasury issue further guidance, according to a press release from the American Hospital Association.
On Feb. 10, following a Feb. 6 court ruling, CMS instructed certified IDR entities to hold all payment determinations until the departments issued further guidance. The court ruling by the U.S. District Court for the Eastern District of Texas found that the revised arbitration process favors commercial insurers in violation of the compromise Congress reached in the act. This decision vacated the regulations nationwide.