High volume has created a backlog that federal departments have to sift through to review and process disputes.
The No Surprises Act may be preventing unexpected bills, but the law's independent dispute resolution (IDR) process is being used significantly more than the federal government anticipated, according to a government report.
HHS, the Department of Labor, and the Department of the Treasury released statistics on the IDR process from April 15 to September 30, 2022, detailing how often providers and payers utilized arbitration to resolve disagreements over payment for items and services after an unsuccessful negotiation period.
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.
The Departments state that disputes reached 18,163 in the second quarter (April 15 to June 30, 2022), including disputes over items and services that would have been eligible for the Federal IDR process beginning January 1, 2022, when the surprise billing protections became effective.
The third quarter (July 1 to September 30, 2022) saw nearly four times as many disputes as the second quarter, totaling 71,915.
Most of the disputes in the second and third quarters were for emergency or non-emergency items or services and most of those disputes were submitted by out-of-network providers and facilities.
Of the total disputes initiated, 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 The remaining closed disputes were either withdrawn by the disputing parties, were closed because the parties reached an outside settlement, or were closed for other reasons, such as incorrect batching, data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 is due to the review and processing time needed to determine the eligibility of disputes.
"It is within this context that the Departments are working to enhance the Federal IDR portal's ability to intake and process disputes and associated data," the report stated.
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.
According to analysis by the Commonwealth Fund, providers are favored in some states' IDR process compared to the federal system, which could lead to higher payments for providers.
Jay Asser is the contributing editor for strategy at HealthLeaders.
KEY TAKEAWAYS
Departments of the government released numbers on the usage of the IDR process from April 15 to September 30, 2022.
Disputes totaled 90,078 over that period, which far exceeded the estimated 17,333 claims annually by the federal government.
The sheer quantity of claims coupled with the time needed to review them for eligibility is forcing the Departments to enhance the IDR portal's ability.