CMS resumes all No Surprises Act payment determinations

CMS has instructed all independent dispute resolution entities to resume issuing No Surprises Act payment determinations involving out-of-network services and items.

The agency had paused all payment determinations in early February following a federal court decision in Texas that ruled its arbitration process "continues to place a thumb on the scale" in favor of insurers.  

Payments were partly resumed in late February, and CMS said March 17 that all certified IDR entities can resume making payment determinations for disputes centered on or after Oct. 25, 2022. IDR entities should use CMS' revised final rules from August 2022 as guidance during arbitration.

Also starting March 17, disputing parties will start to receive a majority of their payment determination notices from the IDR portal, specifically from 

Updated guidance for IDR entities issuing payment determinations on or after Oct. 25, 2022, is here. Updated guidance for disputes on or after Oct. 25, 2022, is posted here.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months