The Centers for Medicare & Medicaid Services (CMS) launched the Federal Independent Dispute Resolution (IDR) system on Aug. 16, 2022. CMS explained that some disputes are taking longer  to process than anticipated during the program’s initial implementation as parties gain more understanding of the procedure. In response, CMS issued guidance for parties initiating an IDR dispute under the No Surprises Act. According to CMS, the released tips are intended to help ensure disputes are processed as quickly and efficiently as possible.

 

The guidelines address:

  • Common mistakes, such as incorrectly batching cases or submitting disputes involving bundled qualified IDR items
  • Communicating the proper information and contact information
  • Submitting required fees
  • Ensuring that the dispute initiation is complete
  • Properly submitting batched disputes or single disputes involving bundled qualified IDR items or services
  • Getting additional help and sending questions to the federal IDR

 

In response to delays, CMS notes that requests for extensions made by the parties or certified IDR entities are being granted, as appropriate.

 

Sources:

https://www.cms.gov/nosurprises/help-resolve-payment-disputes/Tips-for-Disputing-Parties

https://www.cms.gov/nosurprises/help-resolve-payment-disputes/payment-disputes-between-providers-and-health-plans