The Centers for Medicare and Medicaid Services (CMS) has instructed Independent Dispute Resolution (IDR) entities for the federal No Surprises Act to resume arbitration proceedings, but only for payment disputes on out of network services incurred prior to October 25, 2022. Arbitration proceedings for services incurred after October 25 continue to be on hold due to a recent U.S District Court decision. The court determined that the instructions provided to the IDR entities still improperly favors the rate proposed by insurers.
According to the CMS guidance, certified IDR entities will continue to hold issuance of payment determinations that involve items or services furnished on or after October 25, 2022 until the Departments (Health and Human Services, Labor, and Treasury) issue further guidance. The Departments are working diligently to complete necessary guidance and system updates in order to allow certified IDR entities to resume processing payment determinations for these disputes. (Andrew Busz, firstname.lastname@example.org)