Phia Group

IDR Entities Still Struggling with Volume – Highlights from the Q4 2022 Report

On July 17, 2023
Under the No Surprises Act (NSA), the Departments of Health and Human Services, Labor, and Treasury are required to post quarterly data on the Federal Independent Dispute Resolution (IDR) process. In response to the federal court decision in Texas Medical Association, et al. v. United States Department of Health and Human Services, portions of the governing regulations were vacated, resulting in a February 10, 2023 order for IDR entities to cease issuing new payment determinations (see https://www.cms.gov/nosurprises/help-resolve-payment-disputes/payment-disputes-between-providers-and-health-plans). This was lifted as of February 24, 2023 for services furnished before October 25, 2022, and as of March 17, 2023 for services furnished on or after October 25, 2022. Because there was essentially a freeze on IDR proceedings for a good portion of Quarter 1 of 2023, the report issued for Quarter 4 of 2022, available at https://www.cms.gov/files/document/partial-report-idr-process-octoberdecember-2022.pdf, is the most recent and complete picture we have of how the process is performing.