CMS Discover: Fee Disputes Between Suppliers and Well being Plans (Feb. 10, 2023)

Obtainable at https://www.cms.gov/nosurprises/help-resolve-payment-disputes/payment-disputes-between-providers-and-health-plans

In response to the federal trial courtroom choice vacating parts of the ultimate laws on the shock billing unbiased dispute decision (IDR) course of (see our Checkpoint article), HHS’s Facilities for Medicare & Medicaid Companies (CMS) has directed licensed IDR entities to not concern new fee determinations till they obtain additional steerage from the companies. As well as, any fee determinations issued after February 6, 2023 (the date of the courtroom order), are to be recalled. CMS explains that the companies are within the technique of evaluating and updating the federal IDR course of steerage, methods, and associated paperwork to make them in keeping with the courtroom order however supplies no timeline for the up to date steerage. The IDR course of steerage was lately up to date to mirror the ultimate laws, which had been issued in August 2022 to handle the components that licensed IDR entities could take into account in choosing a celebration’s fee quantity after the identical federal trial courtroom invalidated parts of the interim closing laws (see our Checkpoint article).

EBIA Remark: The CMS discover directs licensed IDR entities to proceed working by way of different components of the IDR course of as they wait for extra course from the companies. Presumably which means disputing events will nonetheless have the ability to submit notices of IDR initiation by way of the IDR portal, additional exacerbating the rising backlog of disputes (see our Checkpoint article).  Additional steerage will probably be welcome. For extra data, see EBIA’s Well being Care Reform handbook at Part XII.B.3 (“Shock Medical Billing: Emergency and Non-Emergency Companies”). See additionally EBIA’s Group Well being Plan Mandates handbook at Part XIII.B (“Affected person Protections”) and EBIA’s Self-Insured Well being Plans handbook at Part XIII.C (“Federally Mandated Advantages”).

Contributing Editors: EBIA Employees.