CMS Continues Implementation of No Surprises Act With IDR Portal and FAQs

April 15, 2022

The No Surprises Act (NSA) went into effect Jan. 1, 2022, with the goal of protecting consumers from unexpected medical bills. The NSA places numerous obligations on certain healthcare providers, facilities and providers of air ambulance services, including notice and consent requirements for consumers’ rights, good faith estimates of charges for care to uninsured individuals and dispute resolution processes. The Centers for Medicare & Medicaid Services (CMS) has continued to release guidance regarding the NSA related to the balance billing prohibition, good faith estimate requirement and independent dispute resolution (IDR) process.

Last week, CMS released two FAQs: one for providers on the NSA’s requirements and another specific to good faith estimates. The first FAQ summarizes provider requirements and prohibitions and provides clarification on IDR fees. The second FAQ answers provider questions related to the content of good faith estimates and when they must be provided, including specific guidance related to recurring items and services and same-day visits. As providers and facilities continue to implement the various NSA requirements to comply with the new rule, the FAQs provide practical guidance to assist providers in this process.

Today, CMS launched the online IDR Portal. The IDR Portal will be used by payors and nonparticipating healthcare providers who seek to utilize the IDR process when they are unable to agree on an out-of-network rate. CMS previously indicated that for disputes for which the open negotiation period has expired, notices of initiation of the IDR process may be submitted within 15 business days following the opening of IDR Portal. Because of the delay in the launch of the IDR Portal, CMS expects that a high case volume will create a backlog of IDR requests now that the IDR Portal is live.

McGuireWoods will release a comprehensive series on the requirements of the No Surprises Act for healthcare providers in the coming weeks. This series will detail (i) mandatory notices and consents for the balance billing prohibition and exceptions, (ii) required content and timing for good faith estimates, and (iii) specifics on the IDR process.