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CMS Suspends IDR Process of No Surprises Act After Federal Court Vacates IDR Fee Increase
The controversial Independent Dispute Resolution (IDR) process of the No Surprises Act was temporarily suspended by the CMS on August 4 due to a federal court ruling that vacated a substantial administrative fee increase and batching rule from the CMS that reportedly curtailed challenges of claim reimbursement by radiologists and other providers.
The Centers for Medicare and Medicaid Services (CMS) has temporarily suspended the Independent Dispute Resolution (IDR) process of the No Surprises Act in the wake of a recent federal court decision to vacate a significantly increased administrative fee and batching rule that CMS had previously instituted for challenges of insurer reimbursement on disputed claims by radiologists and other providers.
In an August 3 decision regarding the Texas Medical Association’s lawsuit against the United States Department of Health and Human Services, Jeremy D. Kernodle, a judge on the United States District Court for the Eastern District of Texas, cited the government’s failure to provide sufficient notification and an appropriate comment period for the administrative fee increase and batching rule as mandated by the Administrative Procedure Act (APA).
“In sum, the Court holds that the (government) improperly bypassed the notice-and-comment requirement in issuing the Fee Guidance and the September Rule’s batching regulations. The Court finds that vacatur of these rules is the proper remedy,” wrote Kernodle, a judge on the United States District Court for the Eastern District of Texas.
In response to the federal court’s decision to negate the IDR administrative fee increase (previously described by the American College of Radiology (ACR) as a 600 percent increase from $50 to $350), the CMS announced a suspension of the IDR process on August 4 in what it referred to as an “unplanned outage.”
“As a result of the TMA IV decision, effective immediately, the Departments have temporarily suspended the Federal IDR process, including the ability to initiate new disputes until the Departments can provide additional instructions,” noted the CMS.
In conjunction with the Texas Medical Association’s original lawsuit against the United States Department of Health and Human Services, the American College of Radiology (ACR) filed an amicus brief on February 21, 2023 along with the American College of Emergency Physicians (ACEP) and the American Society of Anesthesiologists (ASA). In a January 19 letter to the heads of the U.S. Departments of Health and Human Services, Labor and Treasury, William T. Thorwarth, Jr., MD, FACR, the chief executive officer of the ACR, emphasized the cost-prohibitive nature of the increased IDR administrative fee for radiologists.
In an August 4 statement, the ACR praised the federal court decision.
“The court vacated, or nullified, the fee increase and batching rule nationally because the government failed to allow ACR members and others to comment and propose alternative approaches,” noted the ACR.
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