March 06, 2023
Medical associations call on CMS to resume all disputed No Surprises Act payment determinations
WASHINGTON, D.C. — The American College of Emergency Physicians (ACEP), the American College of Radiology® (ACR®) and the American Society of Anesthesiologists (ASA) are urging the Centers for Medicare and Medicaid Services (CMS) to quickly resume all independent dispute resolution (IDR) payment determinations paused by its order on Feb. 6. While CMS provided some relief Feb. 24, when it instructed certified IDR entities to resume making determinations for payment disputes involving services furnished before Oct. 25, ACR, ACEP and ASA call on the agency to resume swift determinations for disputes involving items or services furnished on or after Oct. 25 as well.
CMS temporarily halted the IDR process payment determinations — included in the No Surprises Act passed into law in December 2021 — following a U.S. District Court for the Eastern District of Texas decision in the case of Texas Medical Association, et al., v. United States Department of Health and Human Services. The medical associations assert that the government’s pause exacerbates the existing backlog of IDR determinations, causing harm to healthcare providers who provided those services.
ACR, ACEP and ASA jointly supported the Texas Medical Association’s lawsuit by filing an amicus brief last October. Two additional lawsuits have been filed by the Texas Medical Association addressing the qualifying payment amount (QPA) calculation methodology, the 600% administrative fee increase for the IDR process announced in December and overly restrictive batching rules. ACR, ACEP and ASA filed amicus briefs on the QPA lawsuit in late January and the administrative fee increase and batching lawsuit in February.
About the American College of Radiology
The American College of Radiology (ACR), founded in 1924, is a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of radiological care.
About the American College of Emergency Physicians
The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education, and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million people they treat on an annual basis. For more information, visit www.acep.org and www.emergencyphysicians.org.
About the American Society of Anesthesiologists
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves. For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at . To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook and follow ASALifeline on Twitter.
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