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CMS Reopens IDR Portal For New Single and Bundled Claims

CMS Reopens IDR Portal For New Single and Bundled Claims

The Centers for Medicare and Medicaid Services (CMS) announced on October 6, that it reopened the Independent Dispute Resolution (IDR) portal for new single and bundled claims – but not batched claims. Following a recent court ruling, known as TMA IV, where the $350 administrative fee to participate in the IDR process be vacated, the IDR portal was suspended on August 3 for all claims. On September 21, the portal was partially reopened only for single and bundled claims submitted to the portal on or before August 3. For those submitting single or bundled claims to the IDR where the initiation deadline would have been between August 3 and November 3, there has been a 20-business day extension to initiate a new dispute (normally 4 business days). Additionally, parties will have 10 business days to select an IDR Entity (up from 3 days). Additional information can be found on CMS’ FAQ document published on October 6.

The portal remains closed for all batched claims (new and previously initiated) as CMS works to bring guidance and then portal functions/coding in line with the TMA IV decision that vacated the previously established batching requirements. While frustrating for physicians looking to bring batched claims to the IDR, CMS says it is focused on opening the portal to all claims as soon as possible and will consider similar timeline extensions.

CMS also announced an initial six-month period of enforcement discretion related to another court ruling that vacated many of the provisions related to calculation of the qualifying payment amount (QPA). That case, known as TMA III, challenged the calculation methodology of the QPA, which heavily favored health insurers. CMS states that insurers are expected to calculate QPAs using a good faith, reasonable interpretation of the applicable statutes and regulations that remain in effect after the court decision, but the agency will be working to assist plans with recalculation rather than penalizing them over the next six months. Stakeholders should not expect additional guidance on the QPA calculation during this time. The Administration plans to appeal the TMA III decision. For more information, please review the CMS FAQ document.

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