By Rafael J. Fernandez, Jr., MD
The American Medical Association and associations at all levels of organized medicine have been actively involved in addressing the implementation of the Federal No Surprises Act which provides surprise billing protections for patients and has the potential for significant network disruption. One of the most hotly debated components of the Act was the Independent Dispute Resolution (IDR) process given the potential for the administration of the process to have a significant impact on contractual negotiations and network development at the local level. Failure to implement the IDR process fairly will have major ramifications on care delivery.
On August 19th, the Departments of Health and Human Services (HHS), Labor, and the Treasury (the Departments) released the first update on the volume of disputes that have been filed since the launch of the IDR. For the four-month period from April to August, over 46,000 disputes were filed which according to the Departments were “substantially more than the Departments initially estimated would be submitted for a full year.”
While the volume of disputes is attention catching, the hidden headline is that the certified IDR entities rendered a payment determination in more than 1,200 disputes during this four-month period. For physicians concerned about how the No Surprises Act will change insurance company behavior in terms of contracting and potential reductions in out-of-network payment, the trends and details of these 1,200 decisions are critically important, although not yet available as far as I am aware.
There are several resources available for physicians to follow the implementation of the IDR process. The Departments have launched a comprehensive webpage entitled “Common mistakes and helpful tips for parties initiating an IDR dispute” which includes a link to the portal where disputes can be filed. The AMA has also created a toolkit to guide physicians on the implementation of the No Surprises Act.
The DCMA will continue to update our physician members as more details emerge on dispute resolution trends and determinations from the certified entities.
Dr. Rafael J. Fernandez, Jr., is President, Dade County Medical Association.
