Independent Dispute Resolution (IDR) review decisions have been placed on hold due to a lawsuit brought forth by the Texas Medical Association (TMA). The lawsuit challenges the Final Rules of the No Surprises Act, specifically those relating to how the Qualified Payment Amount (QPA) is considered by IDR entities.
TMA argues that the provisions set forth in the Final Rules unfairly disadvantage physicians in payment disputes. This is the second time the TMA has challenged the federal IDR regulations in court.
In response to the February 6, 2023 ruling, the Centers for Medicare and Medicaid released a statement that effective immediately, certified IDR entities should hold all payment determinations for disputes in progress until further guidance is issued. Those entities should also recall any payment determinations issued after February 6, 2023. The guidance does not direct providers or payors to change current processes or timelines and does not affect the open negotiation process.