HHS has resumed processing some, however not all, of the shock billing impartial dispute decision (IDR) determinations that have been lately suspended in response to a federal trial court docket determination vacating a portion of the ultimate IDR laws (see our Checkpoint article). Earlier this month, HHS’s Facilities for Medicare & Medicaid Providers (CMS) directed licensed IDR entities to not concern new fee determinations till the businesses present additional steering (see our Checkpoint article). As well as, any fee determinations issued after February 6, 2023 (the date of the court docket order), have been to be recalled. CMS additionally defined that the businesses have been within the means of evaluating and updating the federal IDR course of steering, methods, and associated paperwork to make them in step with the court docket order. CMS has now introduced that licensed IDR entities have been instructed to renew processing fee determinations starting February 27, 2023, for disputes involving objects or companies furnished earlier than October 25, 2022, since this stuff and companies will not be affected by the court docket order. Licensed IDR entities are to proceed to carry fee determinations involving objects or companies furnished on or after October 25 till the businesses concern additional steering.

EBIA Remark: The CMS discover advises that disputing events ought to proceed to have interaction in all different elements of the federal IDR course of, together with submitting charges and provides. The businesses are working to finish steering and system updates to replicate the February sixth court docket order whereas concurrently battling a backlog of disputes (see our Checkpoint article). For extra data, see EBIA’s Well being Care Reform guide at Part XII.B.3 (“Shock Medical Billing: Emergency and Non-Emergency Providers.” See additionally EBIA’s Group Well being Plan Mandates guide at Part XIII.B (“Affected person Protections”) and EBIA’s Self-Insured Well being Plans guide at Part XIII.C (“Federally Mandated Advantages”).

Contributing Editors: EBIA Workers.