CMS Pauses NSA IDR Process to Comply with Lawsuit Ruling

The Centers for Medicare and Medicaid Services (CMS) has announced a pause on all claims pending in the No Surprises Act (NSA) independent dispute resolution (IDR) process.  All IDR entities were instructed to “hold all payment determinations” until further guidance is released to comply with the recent Texas Medical Association (TMA) lawsuit ruling.  

A February 6 Texas Federal Court found that current Department guidance unlawfully directed IDR entities to give deference to the insurer calculated qualifying payment amount during consideration of claims disputes. The Court agreed with TMA argument that such deference does not exist in the text of the NSA. A joint amicus brief filed by the American Society of Anesthesiologists (ASA), the American College of Radiology and the American College of Emergency Physicians that supported the TMA’s position was referenced in the Courts ruling. 

According to the CMS announcement, “The Departments will provide specific directions to certified IDR entities for resuming the issuance of payment determinations that are consistent with the court’s judgment and order.”  The Departments have not yet announced the length of the pause.