No Surprises Act: New Federal Independent Dispute Resolution Process

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It just got more difficult to get paid for your out-of-network patient care and services, thanks to the new No Surprises Act Federal Independent Dispute Resolution (IDR) process just implemented.

CMS just launched a new IDR online portal that both providers and payers must utilize to dispute coverage/payments for out-of-network claims. The problem is that the site is live right now and the clock is ticking. You must get up to speed immediately, or payers will have the advantage when it comes to denying your out-of-network claims – something you certainly don’t want.

The complexities of new IDR process have the ability to make it harder than ever to get your out-of-network services paid. Just a few of the challenges you must overcome to win your case include adherence to rapid timelines, calculating Qualifying Payment Amounts (QPA), meeting negotiation documentation expectations, successfully working with newly appointed IDR Process Arbitrators, etc.

The good news is, there is help available…

Healthcare attorneys, Daphne Kackloudis, JD and Ashley Watson, JD, are presenting a 60-minute online training that will walk you through the complexities of entire IDR process. You’ll receive practical, how-to advice to ensure you comply with this new No Surprises Act rule. After attending, you’ll be able to file and combat an out-of-network dispute through the IDR online portal more successfully.

Here are just a few of the Independent Dispute Resolution portal questions you’ll get answered during 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 that must be met?
  • How long is the open negotiation period, and who is responsible for its initiation?
  • What items should be included 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 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 submit 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: Once involved in an IDR, you must meet quick submission deadlines or face severe consequence. If either you or the payer fail to submit your offer by the set timeline, the other party wins the dispute. So, mastering these new IDR rules fast, means you have an advantage. Getting a decision made to meet a fast 10-day deadline can be difficult at a large payer, but you should be able to shift on a dime. As long as you know the rules.

Unfortunately, the new No Surprises Act IDR rule adds more hoops you must jump through to get paid. With that said, figuring out how to correctly make it through the hoops can mean additional payments for out-of-network patients and services that were never available to you before.

Don’t wait, sign up for this expert-led online training right away to ensure you have the skills to file and defend an IDR successfully, and in turn get paid for more of your out-of-network care. Register 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.Associate in BMD's Columbus Office

Ashley is a healthcare attorney in BMD’s Columbus office. She works 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.