More trouble for the IDR process…

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Surprise billing arbitration halted (again)

Tina Reed

8/7/23

https://www.axios.com/newsletters/axios-vitals?id=2&name=Vitals&screen=channel

The process providers and insurers use for settling surprise billing disputes was halted after a federal court found the Centers for Medicare and Medicaid Services improperly hiked the fee for requesting arbitration.

Why it matters: It's another hiccup for the arbitration system, known as the independent dispute resolution process. It's also the second time this year the IDR process has been halted after a court ruling.

What happened: A federal judge sided with the Texas Medical Association in a lawsuit that argued CMS failed to follow proper notice-and-comment procedure when it raised the fee for participating in the IDR process from $50 to $350. CMS upped the fee in December, citing "increasing expenditures in carrying out the Federal IDR process."

• CMS on Friday evening said it temporarily suspended the IDR process, including the ability to file new disputes.

Catch up quick: The arbitration system has been loaded up with disputes, meaning some cases have dragged on for months. Some providers have also recently complained that insurers have ignored or failed to fully adhere to arbitration rulings.

• The IDR system was paused for about five weeks earlier this year after the same Texas physician group challenged a separate part of the IDR process, which it said favored insurers.