HHS received 13 times as many IDR submissions than anticipated

Wednesday, February 28, 2024

Payers and providers initiated 288,810 disputes through the federal independent dispute resolution (IDR) portal between January 1 and June 30, 2023, according to a recent CMS report. This amount is 13 times greater than what HHS anticipated for the entire calendar year.

The number of disputes per quarter is continuing to increase, according to HHS. The department revealed that 110,034 disputes were initiated in the fourth quarter of 2022, 136,111 in the first quarter of 2023, and 152,699 in the second quarter of 2023.

Certified IDR entities have bolstered their operations to address the high volume of disputes, CMS said. The entities rendered 83,868 payment determinations in the first half of 2023, which is five times as many determinations made in all of 2022.

For non-air ambulance disputes, emergency services and radiology services made up the majority of payment determinations in the first half of 2023. Providers, facilities, or air ambulance providers were the prevailing party in approximately 77% of determinations. The prevailing offer was higher than the qualifying payment amount in 82% of determinations.

Certified IDR entities closed 134,036 disputes in the first half of 2024. Disputes are considered closed if they resulted in a payment determination, were deemed ineligible for the federal IDR process, were withdrawn, reached a settlement, or ran into administrative issues.

Processing delays were primarily caused by the complexity of determining eligibility for the federal IDR process. Approximately 22% of disputes in the first half of 2023 were ultimately determined ineligible. However, disputes were less likely to be found ineligible during this period than in 2022 (46%).

This trend could be credited to newly added instructions from HHS on required data elements and attachments.

Revenue integrity professionals should review guidance on the No Surprises Act. As HHS continues its efforts to increase the efficiency of the federal IDR process, providers must make sure to include all information requested by HHS for disputes initiated in the IDR portal.

Editor's note: Find more NAHRI resources on the No Surprises Act here.