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MGMA Recommends Priority Changes to Improve IDR Portal

Analysis  |  By Jay Asser  
   May 19, 2022

CMS receives comments on the next update to the dispute resolution process as part of the No Surprises Act.

The Medical Group Management Association (MGMA) has offered recommendations to improve the independent dispute resolution (IDR) portal ahead of its next update.

In a letter to CMS administrator Chiquita Brooks-LaSure, MGMA outlines three priority changes to the IDR portal, which is used to dispute out-of-network claims protected under the No Surprises Act.

The IDR process has been under constant scrutiny since the No Surprises Act went into effect on January 1, with several organizations filling lawsuits against the Department of Health and Human Services over the arbitration.

As such, MGMA, which represents more than 15,000 medical groups comprising of more than 350,000 physicians, believes streamlining the process and making it as efficient as possible would be greatly beneficial to providers.

"Practices are struggling with staffing shortages, additional administrative costs, inflation, the looming end of the public health emergency and resulting changes in healthcare policy, as well as implementing new processes and practices to comply with other requirements under the No Surprises Act," MGMA writes. "The support of a more robust IDR Portal would be especially impactful for smaller and rural practices, that are unable to quickly adapt to changing policies and less financially resilient."

MGMA's three priority recommendations are:

  1. Enabling communication between disputing parties and the selected IDR entity via the platform.
     
  2. Providing the ability to edit an application after entering information.
     
  3. Updating specific form field requirements.
     

Communication via the IDR portal

MGMA is asking CMS to develop a platform with the capability to allow all parties engaged in a dispute to communication through the portal during the resolution process.

As it stands, a party must download the submitted IDR claim and email it to the non-initiating party, which can burden smaller practices to manually track claims and administratively challenge larger practices with higher volumes, according to MGMA.

"An interactive platform that tracks existing disputes, incorporates a clear timeline for the required process, and serves as a communication platform among all involved parties is critical to reduce the current burden for disputing parties and ensure the IDR process is accessible to all practices," MGMA states.

Editing existing applications

To allow practices to return to an IDR form later, MGMA wants CMS to add in the function of saving an application that can be accessed through a practice login.

In addition, MGMA recommends that all redundant information throughout the IDR claim—such as dates and contact information—be auto populated, while creating a function that allows for the editing and viewing of saved line items.

Updating form fields

Lastly, MGMA asks that CMS adjusts what information is required to better reflect the different information providers and payers have available to them.

Specifically, this means incorporating or altering the following form fields:

  • Adding an identifier field that providers and insurers can leverage to ensure both parties understand which services are being disputed.
     
  • Making the form field to input the qualified payment amount optional for providers and facilities.
     
  • Making the form field for insurer type optional for providers submitting an IDR initiation.

Additional recommendations

Along with the recommended priority changes, MGMA suggests that CMS also create a timeline of the IDR process, provide additional education and make adjustments to the batched submission process, and continue to engage with providers and health plans on best practices to submit claims.

Jay Asser is the contributing editor for strategy at HealthLeaders. 


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