The Centers for Medicare & Medicaid Services has reopened the independent dispute resolution (IDR) portal for new single and bundled – but not batched – claims.
Following the recent decisions in TMA’s third (TMA III) and fourth (TMA IV) lawsuits, the IDR portal was suspended on Aug. 3 for all claims. On Sept. 21, the portal was partially reopened only for single and bundled claims submitted to the portal on or before Aug. 3.
For those bringing single or bundled claims to IDR where the initiation deadline would have been between Aug. 3 and Nov. 3, there has been a 20-business day extension to initiate a new dispute (normally four business days), explains an American Medical Association (AMA) email communication. Additionally, parties will have 10 business days to select an IDR entity, up from three days.
See this CMS FAQ regarding IDR for details.
“CMS said the portal remains closed for all batched claims – new and previously initiated – as the agency works to bring guidance and then portal functions/coding in line with the TMA IV decision that vacated the previously established batching requirements,” AMA said. “While frustrating for physicians looking to bring batched claims to IDR, CMS has assured us they are focused on opening the portal to all claims as soon as possible and will consider similar timeline extensions.”
In addition, CMS announced a period of enforcement discretion related to use of qualified payment amounts (QPAs) calculated under the methodology that was partially vacated by the court in the TMA III decision. CMS states that plans are expected to calculate QPAs using a good faith, reasonable interpretation of the applicable statutes and regulations that remain in effect after the TMA III decision, but the agency will be working to assist plans with recalculation rather than penalizing them over the next six months.
“Stakeholders should not expect additional guidance on the QPA calculation during this time,” the AMA communication said, adding that “the administration plans to appeal the TMA III decision.”
For more information, see this CMS FAQ regarding the QPA.
Last Updated On
October 11, 2023
Originally Published On
October 11, 2023