No Surprises Act: IDR Portal Now Open for Business

The federal government has now launched the independent dispute resolution process.

The Biden Administration has extended the COVID-19 public health emergency (PHE) for another 90 days, just ahead of its expiration date this past Saturday. This will provide an extension to certain pandemic flexibilities through mid-July; for instance, the PHE makes it easier for people to access health insurance under Medicaid, expands access to telehealth services, and allows agencies to fast-track authorization for COVID tests and vaccines.

And if you remember, in its spending bill, Congress further extended telehealth coverage of Medicare for another five months after whenever the emergency ends, so this means that the telehealth waivers will now continue to at least mid-December.

Also last week, we saw quite a bit of news on the No Surprises Act.

On Friday, the Centers for Medicare & Medicaid Services (CMS) opened the government portal whereby providers and other parties can initiate an arbitration process – or an independent dispute resolution process – if they are unhappy with their reimbursement for out-of-network claims protected by the Act.

Those claims include all out-of-network emergency claims, plus non-emergency out-of-network claims in in-network facilities. The No Surprises Act lays out a process providers can use if they are unhappy with how a payer has reimbursed them for these claims, including a 30-day negotiation period with the payer, followed by the opportunity to go through dispute resolution with an independent third-party arbitrator.

So, now that the portal is open, if a provider has gone through that negotiation period with the payer anytime since January, they now have three weeks from today to initiate an dispute resolution through the portal.  

The CMS No Surprises Act website also has a number of other functionalities up and running, including the ability for providers to submit complaints against health plans that the providers believe are not complying with the process for settling reimbursement. It also includes the ability for consumers to submit complaints about providers and any medical billing experiences.  

Also last week, CMS released a number of new guidance documents on the No Surprises Act, including two FAQs on the independent dispute review process and an FAQ for consumers on their rights. In the consumer rights guidance, CMS reiterated that a patient does not have to sign a notice and consent form that waives their right to balance billing protections in certain non-emergency situations.

In related news, the Administration plans to clamp down on egregious provider billing, according to reforms announced last Monday. The effort aims to take on providers that offer predatory payment plans to eligible patients, noting that lawsuits against patients have increased. As part of the initiative, the Administration plans on requesting data from more than 2,000 providers on medical bill collection practices.

There’s also a plan to help over half a million low-income veterans get their medical debts forgiven, which will open up new opportunities for people with medical debt to buy a home.

This initiative builds on some of the other moves by the government with regard to medical debt. A few weeks ago, we heard that the credit reporting bureaus are removing medical debt as a factor in credit ratings. And getting back to our theme of the No Surprises Act, the Administration has also issued a warning to collection agencies about being careful not to go after patients regarding claims that are prohibited … by the No Surprises Act.

Programming Note: Listen to Matthew Albright report the legislative update Mondays on Monitor Monday, 10 Eastern and sponsored by Zelis.

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Matthew Albright

Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services.

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