IDR Dispute Data

Q: The government released data about the Federal Independent Dispute Resolution (IDR) process. What does the data show?

A: The federal government released a significant amount of data on IDR resolutions from the first and second quarter of 2023.

You can see the data at  Federal IDR public use file (IDR PUF) and Federal IDR supplemental tables. Here are some takeaways that include some good news for anesthesiologists: 

Awards 

• Anesthesiologists, physician practices and providers prevailed in the majority (74.3%) of payment determinations during this period. 

• IDR awards for anesthesiology claims were higher than the qualified payment amount (QPA). This confirms what ASA has argued in litigation and in meetings with the federal government: insurer calculated QPAs are inaccurate and unreasonably low.  

• The prevailing offer was higher than the qualifying payment amount in approximately 82% of payment determinations. 

• Some physician practices and providers benchmarked their offers to past in-network rates with either the disputing insurer or with a different insurer in the same state. 

Number of IDR Disputes 

• IDR entities rendered 83,868 payment determinations in the first six months of 2023, more than five times the number of payment determinations made in all of 2022 (16,238). 

• IDR entities made 26,741 payment determinations in the first quarter of 2023, 64% more than the prior quarter, and made 57,127 payment determinations in the second quarter of 2023, which was more than twice the number from the prior quarter. 

• IDR entities closed 134,036 disputes in the first six months of 2023. 

• IDR entities rendered 2,350 payment determinations for anesthesia claims.   

• Despite the increase in the number of payment determinations, due to the high volume of disputes initiated, there are disputing parties who are still awaiting eligibility and payment determinations. The document claims that a primary cause of delays in processing disputes is the complexity of determining whether disputes are eligible for the Federal IDR process. 

• During the first six months of 2023, non-initiating parties challenged the eligibility of 106,038 disputes. ASA continues to monitor litigation efforts and its implications for anesthesia practices and advocate for expanded batching and necessary enforcement of payer’s requirements including transparent and accurate calculations of the QPA. ASA will keep members informed. As always, reach out directly to ASA’s NSA team to share your experiences at [email protected] or via this 5-minute survey. ASA anonymously shares member experiences with the legislators and federal agencies involved in making and implementing NSA rules and processes.