CMS is raising concerns about growing costs and payment problems in the federal independent dispute resolution process created by the No Surprises Act and met with every certified independent dispute resolution entity Oct. 1 to talk about possible changes.
CMS Administrator Mehmet Oz, MD, Department of Labor Assistant Secretary Daniel Aronowitz, and officials from HHS, the Labor Department and the Treasury Department attended the meeting, according to an Oct. 2 CMS news alert.
Here are five things to know:
1. The federal IDR process lets independent arbitrators settle out-of-network payment disputes between providers and health plans when the two sides cannot agree. Since it started in April 2022, it has received and closed more than 7 million disputes, which CMS said far exceeds expectations.
2. CMS said the departments and IDR entities have made progress on how quickly disputes are handled, but case volume and the costs tied to the process keep climbing rapidly. The agency said the process was originally expected to reduce net costs to the U.S. healthcare system.
3. Users of the process have raised three main concerns, according to CMS: ineligible disputes, unclear rationales for arbitrators’ decisions, and late payment or nonpayment after a dispute is decided. Providers win about 80% of No Surprises Act arbitration cases, according to research published in December by the Elevance Health Public Policy Institute.
4. The meeting builds on reforms in the federal IDR operations final rule, finalized in May, and on the planned move from the current federal IDR portal to a new IDR gateway, which is set to launch in late 2026.
5. CMS did not announce any policy changes. It said it will consider the arbitrators’ input as it continues to “explore all available regulatory and operational solutions.”
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
