Certified IDR Entities Have Been Instructed to Hold All Payment Determinations Until Further Guidance Is Issued

On February 10, 2023, 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. Additionally, they stated that those entities should recall any payment determinations issued after February 6, 2023. This is in response to the February 6, 2023 ruling on the second TMA lawsuit challenging how QPA must be considered by IDR Entities. The guidance also requires IDR entities to continue their other functions, including eligibility determination. The guidance does not direct providers or payors to change anything about their current process or timelines, nor does it impact the open negotiation process.

Claritev believes that any cases currently in arbitration may take longer than expected to resolve as a result of this directive. CMS’s timeline for finalizing guidance revisions after the court’s ruling in Texas Medical Association’s first lawsuit was just over one month. A similar amount of time could pass before CMS issues further guidance on this second TMA suit.