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- CMS finalizes No Surprises Act dispute changes
The Centers for Medicare & Medicaid Services (CMS) has finalized updates to the federal independent dispute resolution (IDR) process under the No Surprises Act, incorporating several changes for which the CAP has long advocated.
The impact: The final rule includes updates aimed at improving access to the IDR process and reducing administrative burden for physicians, including pathologists.
- CMS will centralize the open negotiation process through a federal IDR portal, creating a more standardized and transparent system.
- The rule adds flexibility for batching claims, particularly for specialties like pathology that often have lower reimbursement services.
- CMS increased the batching limit from 25 to 50 items, reversing course on a previous proposal and aligning with the CAP's recommendation.
- The administrative fee for disputes will be reduced to $15 per part.
- These changes make the IDR process more accessible for pathologists, especially for lower-dollar claims that may otherwise be difficult to pursue.
What’s next: CMS will begin implementing the updated IDR process as stakeholders review the final rule and related guidance.
Go deeper: Review CMS' Federal IDR fact sheet