No Surprises Act Updates
No Surprises Act UpdatesBy: American Medical Association
CMS announced today that it is has reopened the Independent Dispute Resolution (IDR) portal for new single and bundled (but not batched) claims. Following the TMA III and TMA IV decisions, the IDR portal was suspended on August 3 for all claims, and on September 21, the portal was partially reopened only for single and bundled claims submitted to the portal on or before August 3. For those bringing single or bundled claims to IDR where the initiation deadline would have been between August 3 and November 3, there has been a 20-business day extension to initiate a new dispute (normally 4 business days). Additionally, parties will have 10 business days to select an IDR Entity (up from 3 days). See this CMS FAQ for details. The portal remains closed for all batched claims (new and previously initiated) as CMS works to bring guidance and then portal functions/coding in line with the TMA IV decision that vacated the previously established batching requirements. 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.
CMS also announced an initial six-month period of enforcement discretion related to the TMA III decision, which vacated many of the provisions related to calculation of the qualifying payment amount (QPA). 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 Administration plans to appeal the TMA III decision. For more information, see this CMS FAQ.