Physicians needing to formally settle a dispute with insurers over certain out-of-network payments under the federal No Surprises Act finally can initiate that process online.
The Centers for Medicare & Medicaid Services (CMS) on April 15 opened the portal where physicians, other practitioners, and insurers can start the independent dispute resolution (IDR) process under the 2020 federal law, which is meant to curb so-called “surprise” medical bills.
Under the No Surprises Act, before parties can initiate the IDR process through the portal, they must first attempt to solve their billing dispute during a 30-business-day open negotiation period. After that, they normally will have four business days to initiate IDR through the new portal.
However, the Texas Medical Association’s successful lawsuit against federal agencies over some of the rulemaking tied to the No Surprises Act has prompted CMS to give a longer grace period for IDR parties whose open negotiation period ended before the April 15 launch date, CMS says in a statement announcing the opening of the portal.
Disputing parties whose open negotiation period expired before April 15, 2022, will get 15 business days to file an initiation notice via the IDR portal, CMS notes.
In order to start that process, the initiating party must provide:
- Information to identify the qualified IDR items or services;
- Dates and location of items or services;
- The types of items or services (e.g., emergency services);
- Codes for the corresponding service and place of service;
- Attestation that the items or services are within the scope of federal IDR; and
- The initiating side’s preferred certified “IDR entity,” informally known as an arbiter.
Federal regulators have made the following resources available to help physicians navigate the No Surprises Act, and its federal IDR process:
Find more help on the CMS No Surprises webpage, as well as through two American Medical Association toolkits on the law. And TMA offers a wealth information on surprise billing, including a comparison chart between the federal law and Texas state law, on its Surprise Medical Bills page.
Last Updated On
February 10, 2023
Originally Published On
April 20, 2022