CMS Halts IDR Process After Texas Court Ruling

On February 10, 2023 CMS instructed Independent Dispute Resolution (IDR) entities to hold all payment determinations in out-of-network disputes until CMS could issue additional guidance. The CMS announcement comes after the February 6 Texas District court ruling backing the Texas Medical Association’s claim the IDR process as described in the final rule contradicted language in the No Surprises act.

On the CMS No Surprises Act website, CMS stated “As a result of the TMA II decision, the Departments are in the process of evaluating and updating Federal IDR process guidance, systems, and related documents to make them consistent with the TMA II decision. Effective immediately, certified IDR entities should not issue new payment determinations until receiving further guidance from the Departments. Certified IDR entities also should recall any payment determinations issued on or after February 6, 2023. Certified IDR entities should continue working through other parts of the IDR process as they wait for additional direction from the Departments."

Visit XiFin's No Surprises Act Resource Center for additional information on the No Surprises Act.