UPDATE: The Independent Dispute Resolution portal is now online as of noon Friday, April 15. You can find it here: https://nsa-idr.cms.gov/paymentdisputes/s/.
Out-of-network surprise billing protections through the No Surprises Act have been in place since January 1, 2022. Generally, the law protects patients from out-of-network cost-sharing for emergency services or certain out-of-network services provided at in-network facilities, but it also creates an Independent Dispute Resolution (IDR) Process for providers and payers to resolve disputes over how such services should be compensated, as well as providing additional consumer protections for uninsured patients.
The Departments of the Treasury, Labor, and Health and Human Services (the Departments) and the Office of Personnel Management (OPM) have published several final rules outlining how the law would be enforced. Now, additional guidance and FAQs have been released, along with an announcement about the impending launch of the online Independent Dispute Resolution (IDR) portal.
Here’s a breakdown of recent updates.
Two recent FAQ documents have been released about the implementation of the No Surprises Act.
- On April 5, the Departments released additional FAQS about Good Faith Estimates (GFE) for Uninsured or Self-Pay Patients. This document builds on an earlier set of FAQs from December 2021. This latest set of FAQs covers some of the details of what information should be included in GFEs and when.
- On April 6, the Departments released a set of general FAQs about the No Surprises Rules. These FAQs are particularly helpful in laying out all of the various requirements and possible exceptions in easy to read tables.
Updated information about the IDR process also has been published.
Back in February, Judge Jeremy D. Kernodle of the U.S. District Court for the Eastern District of Texas found portions of the IDR process to be inconsistent with the No Surprises Act, namely the requirement for arbitrators to give priority consideration to the qualifying payment amount (QPA) when selecting between two payment offers. Judge Kernodle’s ruling said those portions should be withdrawn and invalidated immediately on a nationwide basis.
Shortly after, the Centers for Medicare and Medicaid Services (CMS) announced that effective immediately the Departments were withdrawing guidance and documents that were based on, or that refer to, the portions of the Rule that the court invalidated and would “promptly repost” the updated documents.
In the past couple of days, those updated documents have now been posted.
- Federal Independent Dispute Resolution (IDR) Process Guidance for Certified IDR Entities
- Federal Independent Dispute Resolution (IDR) Process Guidance for Disputing Parties
These documents offer detailed instructions for how to initiate the dispute process, along with timelines and criteria for how disputes will be resolved. As expected, references to the flawed QPA presumptive policy have been removed.
CMS also announced that the IDR portal would be launched the week of April 11, 2022 (though as of the time of publication, the portal is not yet available.) When it is launched, users can find the IDR portal at https://nsa-idr.cms.gov/paymentdisputes/s/.
Once the IDR portal is launched, disputing parties will have 15 business days to initiate the IDR process for disputes that have already completed the 30-day Open Negotiation process. The timeframe will typically be four business days, but the Departments extended the period while they are getting the portal up and running.
For more information about the No Surprises Act and its implementation, visit https://www.cms.gov/nosurprises.
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