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- Some Surprise Medical Billing IDR Payment Determinations Resume
The government resumed processing some, but not all, of the surprise billing independent dispute resolution (IDR) determinations recently suspended in response to a federal trial involving the Texas Medical Association. The Centers for Medicare & Medicaid Services (CMS) had paused IDR payment determination processing earlier in February after the US District Court for the Eastern District of Texas ruled in favor of the Texas Medical Association and vacated parts of federal regulations implementing the IDR process under the No Surprises Act.
In mid-February, the CMS directed certified IDR entities not to issue new payment determinations until the HHS agencies provide further guidance. The CMS has now announced that certified IDR entities have been instructed to resume processing payment determinations beginning February 27, 2023, for disputes involving items or services furnished before October 25, 2022, since these items and services are unaffected by the court order. Certified IDR entities are to continue to hold payment determinations involving items or services furnished on or after October 25 until the agencies issue further guidance.
The CMS previously said that the Departments of Health and Human Services, Labor, and the Treasury were reviewing the court’s decision and evaluating IDR processes, guidance, templates, and systems.