CMS Withdraws Guidance on Surprise Billing, Out-of-Network Payment Disputes

The Centers for Medicare and Medicaid Services (CMS) has withdrawn guidance on specific parts of the independent dispute resolution (IDR) process for provider-insurer out-of-network care payment disputes in the agency’s Surprise Billing Interim Final Rule. CMS took the action following a Feb. 23 U.S. District Court for the Eastern District of Texas ruling to vacate parts of the rule — as asked for in a suit filed by the Texas Medical Association.

March 8, 2022 — The Centers for Medicare and Medicaid Services (CMS) has withdrawn guidance on specific parts of the independent dispute resolution (IDR) process for provider-insurer out-of-network care payment disputes in the agency’s Surprise Billing Interim Final Rule. CMS took the action following a Feb. 23 U.S. District Court for the Eastern District of Texas ruling to vacate parts of the rule — as asked for in a suit filed by the Texas Medical Association.

In its announcement, CMS pledged to: repost this guidance once it has been revised to conform with the court’s decision; provide training on the new guidance for arbitrators, providers and insurers; and open the independent dispute resolution portal for dispute submissions.

The federal government has until April 24 to appeal the Texas ruling that the IDR provisions violated the Administrative Procedure Act. If the federal government does not appeal that ruling, federal agencies will be required to revise the sections of the rule to bring them into compliance with the court’s decision.

Similar concerns relating to the IDR process led the American College of Radiology (ACR), American College of Emergency Physicians and American Society of Anesthesiologists to file suit in the U.S. District Court for Northern Illinois. The groups recently filed a motion for summary judgement asking the court to block this part of the rule from being implemented.

Four similar suits have been filed. It is unclear what — if anything — CMS’ move to withdraw guidance may mean regarding the government’s intent to appeal the Texas suit or pursue the other suits. The Texas federal court ruling, the ACR lawsuit and the four other federal cases do not in any way affect the No Surprises Act patient protections or patient out-of-pocket costs.

The ACR will continue to post updates about this important matter. More information about the ACR, ACEP and ASA lawsuit is on the College’s website.

Major Medical Associations Ask Federal Court for Summary Judgement in No Surprises Lawsuit