On Aug. 3, the U.S. District Court for the Eastern District of Texas ruled in favor of the Texas Medical Association in its lawsuit against the Centers for Medicare & Medicaid Services regarding aspects of the No Surprises Act. With this ruling, CMS suspended the Independent Dispute Resolution (IDR) process.
The Court ruled that CMS did not follow processes to increase administrative fees to $350 to be paid by both parties in a dispute and to implement a requirement that all batched items or services share the same service code. The judge ruled that these changes, issued on Dec. 23, 2022, violated the Administrative Procedure Act because they were made without notice or comment.
As a result of the ruling, the administrative fee reverts to the $50 fee established in the original fee guidance issued on Oct. 31, 2022. Until the Departments of Health and Human Services, Labor, and Treasury take action to set a new administrative fee amount, the amount for disputes initiated on or after Aug. 3, 2023, is $50 per party per dispute.
For any party to a dispute initiated on or after Jan. 1, 2023, through and including Aug. 2, 2023, who has paid the administrative fee, the amount remains $350, and the court’s ruling does not require any refunds to be paid. For those parties to a dispute initiated during this period who have not paid, the certified IDR entity must reissue invoices to those parties reflecting the $50 administrative fee.
A page on CMS.gov titled “Common mistakes and helpful tips for parties initiating an IDR dispute,” updated Aug. 7, just days after the Court ruling, instructed parties to a dispute to “[c]arefully follow all instructions to properly submit batched disputes or single disputes involving bundled qualified IDR items or services.”
The Federal IDR portal has not been reopened to submit new disputes.
Sources:
https://www.cms.gov/nosurprises/help-resolve-payment-disputes/tips-for-disputing-parties
