CMS
halts, recalls billing arbitration decisions after Texas court vacates
guidance. CMS
said in a Friday
notice that its departments “are in the process of evaluating and
updating” implementation of the Federal Independent Dispute Resolution process
to be consistent with a February 6
ruling from the U.S. District Court for the Eastern District of Texas.
CMS instructed arbitrators on Friday to immediately stop issuing new payment
determinations until further guidance is available. Further, arbitrators should
recall any payment determinations that were issued after February 6.
District
Court Vacates Provisions of No Surprises Act Final Rule. On February 6, a United
States District Court in Texas vacated provisions of the No
Surprises Act final rule related to the independent dispute resolution (IDR)
process for determining payment for out-of-network services. The district court
granted summary judgment to the Texas Medical Association, which had brought
suit against the US Departments of Health and Human Services (HHS), Labor and Treasury
over the IDR process. The district court held that provisions of the final rule
were contrary to law and therefore in violation of the Administrative Procedure
Act (APA). The order vacated the provisions of the final rule that require IDR
entities to look at the qualifying payment amount (QPA) first and consider
other factors only if those other factors are not already accounted for in the
QPA. The Departments have not yet filed a notice of appeal or amended
their sub-regulatory guidance to align with the district court’s order.
Some older news about it:
HHS
report includes information on operation of the IDR portal from April 15, 2022
through September 20, 2022. Report says that since the Federal IDR portal first
opened, “parties have been submitting significantly more disputes than the
Departments initially projected.” Highlights of selected statistics
in the report include:
- From April 15 – September 30,
2022, disputing parties initiated 90,078 disputes through
the Federal IDR portal.
- Disputing parties initiated
18,163 disputes in the second calendar quarter, including disputes over
items and services that would have been eligible for the Federal IDR
process beginning January 1, 2022, when the surprise billing protections
became effective.
- Disputing parties initiated
71,915 disputes in the third calendar quarter, almost four times more than
in the second calendar quarter.
- Most disputes initiated in the
second and third calendar quarters (86,807) were for emergency or
non-emergency items or services, and the vast majority of the disputes
were submitted by out of network health care providers and health care
facilities.