Federal IDR Process Temporarily Paused

The No Surprises Act gives payers and providers 30 days to settle any disputes on an out-of-network charge.

If an agreement can’t be reached, both parties submit a preferred amount to a third-party arbitrator, which then chooses one—a process referred to as Independent Dispute Resolution (IDR).

CMS announced Friday, August 4, 2023, that it is temporarily suspending the Federal Independent Dispute Resolution (IDR) process effective August 3, 2023.  The decision is in response to a judgment and order issued by the U.S. District Court for the Eastern District of Texas on Thursday, August 3, 2023.  

The two issues that were at issue in the court ruling:

1. Increased administrative fees to participate in the process. Fees increased from $50 to $350
2. Rules pertaining to when providers can create batches of related claims in a single IDR complaint.  View details.

The ruling was not based on the integrity of either element, rather the court took issue with the process in which these processes were initiated. 

A lack of notice and implementation of the comment process to collect solicitation of feedback before the implementation of these processes was the court’s deciding factor.  

As a result, practices will not be able to initiate new disputes and certified IDR entities have been directed to pause all IDR-related activities.  CMS states that the departments are currently reviewing the court’s decision and evaluating the current process of determining the necessary updates. 

CMS has subsequently announced that the administrative fee will be reduced to $50.00, at least for the remainder of 2023, once the IDR process is reinstated. Additionally, the Patient-Provider Dispute Resolution Portal is also temporarily not accepting new disputes. 

CMS expects the updates will be issued in the near future and will provide additional updates at that time.

We are here to help, please reach out if you have any questions.The HANK/ACE Team
aceadmin@aceauditors.com