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Most Disputed Claims Included Emergency Department Codes, Says IDR Report

Analysis  |  By Amanda Norris  
   January 16, 2023

Within the independent dispute resolution (IDR) process of the No Surprises Act, one set of codes encompassed 66% of disputes.

Emergency department visits topped the list of services that triggered a request for an IDR during the second and third quarters of 2022, according to a new report.

The IDR process is a part of the No Surprises Act that allows out-of-network providers and payers to hash out payment for items or services if they aren’t satisfied with the outcome of the open negotiation period that is also mandated by the law.

According to the report, the most common CPT codes disputed were emergency department service codes (66% of disputes), radiology codes (9% of disputes), and anesthesia codes (7% of disputes).

In addition to emergency, radiology, and anesthesia services, “approximately 5% of disputes included surgery codes, such as removals of the appendix or gallbladder and treatment of broken bones, and 4% of disputes included codes for pathology and lab. Approximately 4% of disputes included codes for neurology and neuromuscular procedures such as monitoring of the nervous system during an operation,” according to the report.

The states with the most IDR disputes initiated during this reporting period were Texas, Florida, Georgia, Tennessee, and North Carolina.

The IDR portal was opened on April 15, 2022, just over 15 months after the No Surprises Act was signed into law to protect patients from surprises out-of-network bills. The Departments estimated that 17,333 claims would be submitted in the IDR process annually. In reality, the IDR process saw 90,078 disputes over the aforementioned period in the report, far and away outpacing expectations.

Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.


KEY TAKEAWAYS

The IDR process is a part of the No Surprises Act that allows out-of-network providers and payers to hash out payment for items or services.

The most common CPT codes disputed were emergency department service codes, which covered 66% of disputes.


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