Get Paid for Out-of-Network Denied Services with New Federal IDR Process


Finally, you can get paid for more of your out-of-network services – even if your claims are denied. The catch is that you must master CMS’ recently implemented Federal IDR process (Independent Dispute Resolution).

Sounds easy enough, right? Wrong.

The new IDR process is complex and confusing. In fact, CMS recently reported that 90% of the over 90,000 disputes were related to CPT codes, and most were submitted with missing or incorrect information – meaning that they are not getting paid. But it doesn’t have to be this way. With a bit of expert help, you can successfully maneuver your way through the complexities of the new IDR process and get more of your out-of-network services paid.

Luckily, healthcare attorneys Daphne Kackloudis, Esq. and Ashley Watson, Esq. can help. Daphne and Ashley are presenting a 60-minute online training that will take you through the complete IDR process one step at a time. This online training will help you submit your out-of-network claim disputes into the IDR process portal correctly the first time and get you paid for these services more quickly.

Here are just a few of the plain-English IDR process tactics questions you’ll get answered by attending this 60-minute online training:

  • What is the deadline to formally request an open negotiation?
  • What information is necessary to qualify for the IDR process initiation?
  • What are the formalized IDR notice requirements?
  • How long is the open negotiation period, and who is responsible for its initiation?
  • What items should you include when calculating your offer?
  • When must multiple IDR items and services be batched before submission?
  • What evidence can you submit that will influence a Qualified Payment Amount?
  • How should you calculate IDR fees to avoid duplication?
  • When are IDR rules bifurcated between federal and state regulations?
  • When are you expected to submit an offer to the Certified IDR Entity?
  • How can you qualify for and file a deadline extension?
  • What information are you required to include at the time of the offer?
  • How can you dispute a Certified IDR Entity’s ruling?
  • Who should you notify if a payer fails to comply after an IDR ruling?
  • And so much more…

IMPORTANT: Quickly mastering the new Independent Dispute Resolution rules gives you an advantage. You’ll be able to submit your disputes correctly the first time, meet quick submission deadlines, comply with complex requirements and get your denied out-of-network claims paid.

Yes, this new claim dispute process put in place due to the No Surprises Act does create more hoops you must jump through to get paid. However, figuring out how to correctly make it through these hoops means payments for out-of-network services that were never available to you before – and this upcoming online training can help.

This expert-led online training will help you gain the necessary skills to maneuver through the IDR process successfully and get paid for more of your out-of-network care. The number of registrants for this training is limited. Accordingly, to guarantee your access, reserve your spot soon as possible. Don’t wait. Sign up today.

Meet Your Experts

Daphne Kackloudis
Esq.Partner at Brennan, Manna & Diamond

Daphne L. Kackloudis is a member of the firm, she heads BMD Columbus’ health care practice, and she chairs BMD’s Empowerment and Opportunity (DE&I) Committee. Daphne’s success –and that of her clients – is rooted in the nexus between traditional health care legal services and health care public policy. She has broad and deep experience in health care operations, service delivery, payment systems, and compliance, as well as Medicaid, public policy, and government affairs. Daphne advises health care trade associations and health care providers as outside counsel and in-house as a member of her clients’ senior leadership teams.

Ashley Watson
Esq.Healthcare Attorney

Ashley is Assistant General Counsel at a large hospital network in Columbus, Ohio. Prior to this, Ashley was a healthcare attorney in BMD’s Columbus office. She worked with nonprofit and for-profit health care providers, health care trade associations, individuals, and businesses. Ashley is experienced in healthcare public policy and regulatory compliance, legislative and government affairs, grant administration, and healthcare program operations.