Independent Dispute Resolution (IDR) Tips

Q: What are anesthesia practices doing that have helped them obtain successful resolution of claims submitted through the federal Independent Dispute Resolution (IDR)? 

A: ASA continues to collect information regarding “best practices” in successfully navigating the IDR process.  ASA members and their business managers have shared that they:

• Performed diligence on each of the IDR entities in advance of selection of the IDR entity to ensure selection of the most responsive IDR entity. 

• Provided a comprehensive description of why a higher payment was justified, including previously contracted rates. 

• Proposed reasonable rates aligned with rates in the market that are fair and reasonable, including providing information from FAIR Health data. 

• Ensured all submissions included the required information or documentation. 

• Invested in additional external legal resources to coordinate and compile the collection of information from managed care and revenue cycle departments to formulate responses to each of the factors considered during the arbitration process. 

• Ensured all submissions and additional requests for information were made within the required timelines. 

• When batching claims, the offers tailored specifically to the associated claims, including personal details regarding acuity or other factors, rather than an overly legal or clinical sounding document. 

Consult these documents when beginning the IDR process: 

• List of certified independent dispute resolution entities. There are now 13 certified entities, but at the writing of this question, only 11 were accepting claims. 

• Federal Independent Dispute Resolution (IDR) Process Guidance for Disputing Parties (PDF) 

• Federal Independent Dispute Resolution (IDR) Process Guidance for Certified IDR Entities (PDF)