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September 30, 2021

CMS Issues Interim Final Rule on Surprise Billing Dispute Resolution Process

The Centers for Medicare & Medicaid Services (CMS) has released an interim final rule (IFR) establishing the independent dispute resolution (IDR) process for surprise billing disputes and a similar process for uninsured/self-pay patients, as required by the No Surprises Act. The rule requires arbitrators to look primarily to the qualifying payment amount (QPA) in determining the appropriate payment rate, typically the median in-network contracted rate. The hospital industry has been advocating for equal weight to be applied to a range of factors, including quality and patient outcomes, patient acuity, teaching status. The IFR provisions are set to take effect January 1, and comments will be due December 6.