Independent Dispute Resolution process

Federal Health Policy Update for August 6

Don’t Miss: CMS issues final FY 2027 Medicare inpatient payment regulation HRSA introduces revised 340B rebate model CMS gives states new tool to help identify non-citizen Medicaid applicants The following is the latest health policy news from the federal government for July 31 to August 6. Some of the language used below is taken directly from government documents. Congress The Senate is expected to vote on its version of a continuing resolution (CR) before leaving for recess; it would extend federal government funding through December 11. Notably, the legislation includes language that would prevent the Office of Management and Budget [...]

joe2026-08-06T17:32:05-04:00August 6, 2026|340b, Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Developments in No Surprises Act/Independent Dispute Resolutions

Recent weeks have seen several developments and new information in the use of the No Surprises Act’s independent dispute resolution process for health care billing disputes between payers and providers over out-of-network care. The number of disputes directed to independent dispute resolution continues to rise – 16 percent more during the second half of 2025 than during the first half of that year. Providers continue to initiate about three-quarters of the disputes and to win about 85 percent of those cases. Most of the provider-driven disputes are intiated by small provider groups, many of them represented by just a few [...]

joe2026-07-23T15:42:59-04:00July 27, 2026|Uncategorized|

Federal Health Policy Update for June 4

Don’t miss: CMS publishes new Medicaid work/community engagement requirements Energy and Commerce Committee looks at price transparency in health care An AI executive order and Congress prepares to weigh in Price cut: IDR dispute fee to fall from $115 to $15 per dispute The following is the latest health policy news from the federal government for May 29 to June 4. Some of the language used below is taken directly from government documents. Medicaid Work Requirements – Interim Final Rule CMS has published an interim final rule with comment period to implement the Medicaid work and community engagement requirements [...]

joe2026-06-04T16:30:46-04:00June 4, 2026|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare|

CMS Plans IDR Changes

The Independent Dispute Resolution process that is the central implementation mechanism of the No Surprises Act will soon undergo reengineering. Working with the Labor Department and the Department of the Treasury, the Centers for Medicare & Medicaid Services plans to transition the IDR process from single-use web forms into a new IDR gateway later this year. Previewing a process that it anticipates officially unveiling in the near future, CMS notes that through this new gateway, users be able to start and respond to disputes; gain access to dispute dashboards and reports associated with their organization; track dispute information, including disputes [...]

joe2026-03-17T13:55:25-04:00March 18, 2026|Centers for Medicare & Medicaid Services|

Groups Protest No Surprises Act Implementation

A group of more than 60 health care payers, employer groups, and others have written to the departments of Health and Human Services, Labor, and the Treasury to protest how the Independent Dispute Resolution process created under the No Surprises Act is deciding pay disputes between providers and insurers. The letter accuses payers of using the Independent Dispute Resolution process as a money-making tool. It also maintains that the panels deciding the disputes are favoring providers – which are winning 85 percent of the cases they consider – and are operating without sufficient guidance from federal regulators. It also notes [...]

joe2026-02-25T13:05:12-05:00February 26, 2026|Uncategorized|

Providers Continue to Dominate Fee Dispute Resolution

Health care providers won the vast majority of the fee disputes adjudicated through the No Surprises Act’s Independent Dispute Resolution process during the first half of 2025. The volume of those disputes submitted to arbitration rose nearly 40 percent over the first half of 2024, to 1.2 million cases, and the victory rate of providers also rose, from 85 percent to 88 percent.Leading the way for providers were private equity-backed parties, with three such companies accounting for 44 percent of the disputes submitted during the first half of 2025 and ten of those companies filing nearly 70 percent of all [...]

joe2026-01-28T13:02:20-05:00January 29, 2026|Uncategorized|

Controversy Over No Surprises Act Continues

Providers and payers continue to wage war over how the No Surprises Act is being implemented. The law, enacted in 2020, was intended to prevent insured consumers from receiving surprise medical bills, especially for out-of-network care. While it has achieved that objective to a considerable degree, it has left behind providers complaining they are being underpaid for their services and payers – health insurers – insisting that the process of adjudicating such disputes, through what is known as the Independent Dispute Resolution process, is forcing them to pay far too much for providers’ services. At the heart of the debate [...]

joe2025-12-17T12:57:49-05:00December 18, 2025|Uncategorized|

No Surprises Act’s Dispute Resolution Suspended

When a federal court in Texas rejected an increase in the fee for providers to initiate payment challenges under the No Surprises Act’s Independent Dispute Resolution process, the Centers for Medicare & Medicaid Services quickly suspended use of that process while it reviewed the court ruling – suspended both the adjudication of current complaints and the filing of new ones. Almost as quickly, CMS announced that it would reduce the fee required to initiate payment disputes between providers and payers under the 2020 law that sought to prevent surprise medical bills from $350 to $50 – but it did not [...]

iqtsupport2023-08-18T06:00:20-04:00August 18, 2023|Uncategorized|

Federal Health Policy Update for August 10

The following is the latest health policy news from the federal government for August 4-10. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has temporarily suspended the federal Independent Dispute Resolution process, which adjudicates problems involving surprise medical bills, in the wake of a federal court ruling that found some of the process’s underlying regulations invalid. CMS has directed the certified Independent Dispute Resolution entities to pause all dispute resolution activities. As a result, providers and insurers temporarily cannot initiate new disputes. Learn more from this CMS notice. CMS [...]

iqtsupport2023-08-10T16:32:27-04:00August 10, 2023|Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|