October 17, 2023
On August 24, 2023, the U.S. District Court for the Eastern District of Texas invalidated regulations that establish the methodology insurers use to calculate the qualifying payment amount (QPA) (the median in-network payment rate) in surprise-billing disputes – part of a series of federal rules being challenged in court by the Texas Medical Association (TMA) with support from the California Medical Association (CMA) because they skew the arbitration process in insurers’ favor. Following the decision, the federal agencies temporarily suspended all federal independent dispute resolution (IDR) process operations.
On October 6, 2023, the departments reopened the IDR portal for the initiation of new single disputes, including single disputes involving bundled payment arrangements. The law allows physicians to bundle same or similar claims for IDR. Processing of in-progress batched disputes, new batched disputes, and new air ambulance disputes remain suspended while the batching and air ambulance guidance and operations are updated to align with recent court orders.
For more information, see the U.S. Departments of Health and Human Services, Labor, and the Treasury and the Office of Personnel Management (OPM) frequently asked questions (FAQs) that address how plans, issuers, providers, facilities, providers of air ambulance services, and independent dispute resolution entities should proceed in light of the decision.
If CMA physician members have questions about the No Surprises Act's IDR, contact CMA's Center for Economic Services at (800) 786-4262 or email@example.com.