After a Texas federal court vacated a portion of the final regulations on the surprise billing independent dispute resolution (IDR) process, the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) ordered certified IDR entities to stop issuing new IDR payment determination pending further agency guidance. In addition, as per the Court’s order, CMS also recalled any IDR payment determinations issued after the order date of February 6, 2023.
On February 24, 2023, CMS directed certified IDR entities to resume processing new IDR payment determinations for disputes over items or services furnished before October 25, 2022. These determinations were to follow the standards outlined in the October 2021 interim final rules, as revised by the Texas federal court orders. CMS further advised certified IDR entities to refrain from processing any new IDR payment determinations for disputes over items or services furnished on or after October 25, 2022.
On March 17, 2023, CMS posted updated guidance for certified IDR entities to follow when processing IDR payment determinations for disputes over items or services furnished on or after October 25, 2022. CMS also updated guidance for parties to disputes over items or services furnished on or after October 25, 2022. Finally, the agencies updated the Federal IDR portal to reflect the revised payment determination standards.
As a result, CMS also directed certified IDR entities to resume processing new IDR payment determinations for disputes over items or services furnished on or after October 25, 2022. IDR entities should now be processing all new IDR payment determinations for all disputes.
Finally, CMS announced that disputing parties will begin receiving most of their payment determination notices directly from the Federal IDR portal from the following address: auto-reply-federalidrquestions@cms.hhs.gov.
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