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  • Washington Highlights

    CMS Halts IDR After Judge Vacates Fee Increase, Batching Rules Under No Surprises Act


    Gayle Lee, Director, Physician Payment & Quality
    For Media Inquiries

    A federal Judge in Texas ruled that the federal government must vacate its federal fee increase and batching restrictions under the No Surprises Act independent resolution (IDR) process, siding with the Texas Medical Association (TMA) challenge over these provisions. In response to this ruling, the Centers for Medicare & Medicaid Services temporarily suspended the IDR process, effective Aug. 8. 

    This was the third decision in a series of legal challenges from the TMA on the IDR process that is used to determine payment for out-of-network services under the No Surprises Act. The TMA argued that the significant fee increase from $50 to $350 restricted physicians, and the restrictions on batching claims limits physicians’ ability to seek arbitration. The judge ruled that the federal agencies did not follow notice and comment requirements under the Administrative Procedures Act.