After courtroom advocacy by the Texas Medical Association, physicians seeking to resolve out-of-network billing disputes under the No Surprises Act (NSA) received extensions of certain deadlines within the federal independent dispute resolution (IDR) process. However, all currently applicable extensions will end March 14.
That announcement – issued by the U.S. departments of Health and Human Services, Labor, and the Treasury on Feb. 16 – is just one of several recent developments related to the NSA, whose implementation remains fluid and is being closely monitored by TMA.
The NSA, which took effect in 2022, established a federal IDR process through which clinicians can dispute health plans’ initial payment for certain out-of-network care. A certified IDR entity arbitrates these disputes.
TMA has sued federal regulators four times over their implementation of the law, saying it conflicts with the law and skews the IDR process in payers’ favor. Following TMA victories related to these lawsuits, the federal government temporarily suspended all IDR process operations. When the federal government partially reopened the IDR portal in early October 2023, the portal saw an influx of certain single disputes.
Due to this influx, in late November 2023, the departments announced they would grant certain deadline extensions related to:
- Selecting a certified IDR entity;
- A certified IDR entity’s request for additional information to determine a dispute’s eligibility; and
- Submitting offers to a certified IDR entity from which to choose as final payment.
One month later, federal officials extended the extensions from January 2024 to mid-March.
In addition to these extensions expiring, the timeline for resubmitting certain improperly batched disputes will shorten starting March 14. Specifically, initiating parties who submitted a batched dispute before Aug. 3, 2023, and received notification from a certified IDR entity that the dispute was improperly batched, will have the standard four business days – rather than the temporarily extended 10-business-day period – to resubmit their batched dispute.
More information about the IDR process can be found on the Centers for Medicare & Medicaid Services’ dispute resolution webpage.
Last Updated On
March 01, 2024
Originally Published On
March 01, 2024
Emma Freer
Associate Editor
(512) 370-1383