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No Surprises Act IDR Process Once Again Exceeds Utilization Expectations

Analysis  |  By Amanda Norris  
   May 17, 2023

The most recent status update shows the huge influx of disputes.

A total of 334,828 billing disputes have been filed through the independent dispute resolution (IDR) process, nearly 14 times more than initially expected, according to a recent status report.

CMS recently published the status update which displays the latest numbers on initiated disputes, dispute eligibility, and results of payment determinations.

Between April 15, 2022, and March 31, 2023, certified IDR entities rendered payment determinations in 42,158 disputes. Overall, certified IDR entities have closed 106,615 disputes as of the end of March, over four times the volume initially estimated for a calendar year, according to the report.

In addition to confirming an ongoing backlog of IDR cases, the update also revealed a high success for initiating parties (71%), which have largely been providers.

These results aren’t much of a change from previous findings of the IDR process backlog.

For example, a previous report from the third quarter of 2022 saw nearly four times as many disputes as the second quarter, totaling 71,915.

Of the total disputes initiated in that report, 23,107 were closed, 3,576 reached a payment determination, and 15,895 were found ineligible for the IDR process. The remaining closed disputes were either withdrawn by the disputing parties, were closed because the parties reached an outside settlement, or were closed for other reasons, such as incorrect batching, data entry errors, or unpaid fees.

The backlog of disputes from all reports is due to the review and processing time needed to determine the eligibility of disputes.

Providers and payers have struggled to get on the same page on how the IDR process should be settled, with medical associations filing multiple lawsuits contending the emphasis on the qualifying payment amount, or the median in-network rate.

 

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


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