No Surprises Act Dispute Portal Reopens Again Amid ‘Challenging’ Policy Rollout

Healthcare Dive | By Susanna Vogel

The CMS has repeatedly stopped and restarted arbitration this year as court cases snarl regulatory efforts to resolve surprise billing disputes.

Dive Brief:

• The CMS announced on Friday it completed its overhaul of the No Surprises Act dispute resolution process, fully reopening the resolution portal including batched disputes and single disputes for air ambulance services.
• The agency has been incrementally restoring dispute resolution services this year, after a series of lawsuits filed by a Texas provider group prompted the CMS to pause the IDR process multiple times.
• The most recent pause in arbitrations likely contributed to procedural delays and increased the backlog of disputes weighing down the system, according to a new report released by the Government Accountability Office. The report characterized the roll out of the IDR process as “challenging.”

Dive Insight:

The No Surprises Act, which went into effect in January 2022, is meant to protect patients from unexpected medical bills after receiving care from out-of-network providers at in-network facilities.

The dispute resolution process for payments between insurers and providers was meant to be simple. Parties submit a payment offer to a third-party arbiter, who then selects one amount in what is called a final-offer or baseball-style arbitration process. 

However, since the NSA rolled out last year, IDR entities, providers and insurers have reported a fraught IDR process. The dispute portal has been overloaded with claims and subject to multiple pauses after being targeted by lawsuits…

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