The Utilization of Independent Dispute Resolution (IDR) by Payers and Providers. The healthcare industry has seen a significant rise in the use of theFederal IDR Process Federal IDR Process Disputes process to resolve disagreements about payment for items and services covered by the New Surprises Act (NSA). The process has become a popular solution for payers and providers, as they seek to resolve these disputes without involving the government.

A recent government report has revealed that between April 15th and September 30th, 2022, over 90,000 disputes were initiated through the federal IDR portal by payers and providers. This number is significantly higher than the 17,333 claims that were estimated by the Health and Human Services (HHS), Labor, and Treasury departments in a 2021 interim final rule that implemented NSA.

The IDR process was opened to the public on April 15th, approximately 15 months after the NSA was signed into law. Payers and providers can submit a dispute to the IDR if both parties are unable to agree on a payment amount for items and services covered by the NSA. These services include surprise bills for emergency services, non-emergency services furnished by out-of-network providers at in-network facilities, and air ambulance services provided by out-of-network providers.

Through the IDR process, an independent entity, either selected by the disputing parties or the departments, considers payment bids and supporting documentation to determine an appropriate reimbursement rate for the items or services in question.

The increased utilization of the IDR process is a sign that payers and providers are seeking alternative solutions to resolve disputes, and are willing to work together to find a mutually agreed-upon solution. This trend is expected to continue as the healthcare industry adjusts to the new payment and reimbursement regulations under the NSA.

In conclusion, the IDR process has proven to be a valuable tool for the resolution of disputes between payers and providers. Its utilization is expected to increase in the coming years, as both parties seek to resolve these disputes in a timely and cost-effective manner.