The departments of Health and Human Services, Labor and the Treasury issued the No Surprises Act
final rule updating several key regulations. Updates include clarifying information certified independent dispute-resolution entities must consider when making a payment determination under the federal arbitration process.
Other updates from the final rules also:
- Discuss situations in which payers have a down-coded claim.
- Establish new requirements about what information payers must share with providers if a claim is down-coded.
- Provide an FAQ and status report for the independent dispute-resolution process.
Recently, the Centers for Medicare & Medicaid Services launched a new webpage with resources and guidance related to the dispute resolution process under the No Surprises Act, including guidance for disputing parties and a walk through of the federal portal. CMS also has added functionality to the portal for initiating disputes, including a button to upload supporting documents at initiation.