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The Evolution of IDR

The Evolution of IDR
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While federal No Surprise Billing Independent Dispute Resolution (IDR) has only existed since 2022, IDR has undergone continual evolution and significant changes since its inception.

FHAS was one of the first Independent Dispute Resolution Entities (IDREs) certified and approved by the federal government, and our team has unparalleled expertise and historical knowledge to understand exactly how surprise billing disputes should be processed…. and how it will continue to evolve in the future.

FHAS Federal IDR Journey

As of December 15, 2023, recent changes to the IDR batching policies have made IDR more accessible for specialized healthcare providers and health plans to increase IDR’s cost-effectiveness and ease of use. This could potentially open the door for a wider range of claims to be resolved through IDR, significantly increasing the utilization of this dispute resolution method.

In addition to the increased accessibility of IDR for parties, the market is experiencing a surge in activity. October saw a record number of cases initiated, and a recent United States Congress House Ways and Means Hearing, at which FHAS testified, has demonstrated Congress’s long term commitment to the No Surprises Act’s success.
This growth in case filing options, coupled with faster processing times, is encouraging businesses to utilize IDR more as a means of claims resolution. With processing time being the most important criteria for many businesses, IDR’s growing efficiency is attracting a wider range of participants. Over the past year, FHAS has accelerated this efficiency by timely processing a high volume of disputes and issuing payment determinations.

Apr 15, 2022 | Federal IDR Portal Launched

The Departments of Health and Human Services, Labor, and the Treasury (the Departments) launched the Federal IDR portal as required under the No Surprises Act. The statute requires the Departments to publish on a public website certain information about the Federal IDR process.

Jul 26, 2022 | TMA I Ruling

Texas Medical Association (TMA) I Ruling Issued by federal Eastern District Court of Texas:

  • Old standard says -  Information must clearly demonstrate that the qualifying payment amount is materially different from the appropriate out-of-network rate
  • New Standard: IDREs may not apply the vacated standard in reaching a payment determination in any payment dispute; look at all the factors.
Feb 6, 2023 | TMA II Ruling

TMA II Ruling Issued by federal Eastern District Court of Texas:

  • Previous Standard: IDREs directed to consider the QPA first and only consider information other than the QPA if non duplicative; IDREs must explain why that information was not already encompassed in the QPA. 
  • New Standard:  NSA requires arbitrators to consider all the factors listed in the NSA, without granting the QPA special status or imposing burdens on considering other factors.
Aug 3, 2023 | TMA IV Ruling

TMA IV Ruling issued by the federal Eastern District Court of Texas.

  • IDR Portal Shut down; all case submissions paused
  • CMS Administrative Fee changed from a non-refundable $350.00 per party per case to $50.00 per case
  • Previous Batching Rules thrown out
Aug 8, 2023 | Resumption of Batched Disputes Processing

Departments allow IDREs to resume processing of batched disputes only where the batched cases were determined eligible (and fees were paid) prior to August 3, 2023

Aug 24, 2023 | TMA III Ruling

TMA III Ruling issued by federal Eastern District Court of Texas

  • Court vacates various provisions regarding how the QPA is calculated 
  • IDR Portal shut down continues; all case submissions still on hold
Oct 6, 2023 | Federal IDR Portal Reopens for Single Claims

Federal IDR Portal Reopens for submission of single claims only

  • Parties given until November 2023 to file all single submissions previously on hold since August 3, 2023
Dec 15, 2023 | Federal Portal Reopens for Batched Claims

Federal IDR Portal Reopens for submissions of batched claims 

  • The Departments (collectively Departments of Health and Human Services, Treasury, and Labor) give IDREs the discretion to determine batching policy
  • FHAS publishes its batching policy
  • The Departments give parties until March 14, 2023 for parties to submit new batched disputes previously on hold since since August 3, 2023
Jan 22, 2024 | New Fees Take Effect

New fees take effect for any case filed in the federal portal effective January 22, 2024 and after

  • The Departments news proposed administrative fee of $115.00 per per party per case takes effect
  • FHAS maintains its prior year pricing for single and batched cases disputes