As part of the No Surprise Act, CMS will receive comments on the next update to the dispute resolution process.
this Medical Group Management Association (MGMA) Proposed improvements to the Independent Dispute Resolution (IDR) portal ahead of the next update.
The IDR process has been closely watched since the No Surprise Act went into effect on January 1, with several organizations file a lawsuit against this Department of Health and Human Services arbitration.
Therefore, the MGMA, which represents more than 15,000 medical groups, including more than 350,000 physicians, believes that streamlining the process and making it as efficient as possible would be of great benefit to providers.
“Practices are grappling with staffing shortages, additional administrative costs, inflation, the closing public health emergency and resulting health care policy changes, as well as implementing new processes and practices to comply with other requirements of the No Surprise Act ,” MGMA wrote. “Support for stronger IDR portals will have a particularly large impact on smaller rural practices that cannot adapt quickly to changing policies and are less financially resilient.”
The three priority recommendations of the MGMA are:
- Enables communication between disputing parties and selected IDR entities through the platform.
- Provides the ability to edit the application after entering information.
- Update specific form field requirements.
Communicate through the IDR Portal
MGMA asked CMS to develop a platform that would allow all parties involved in the dispute to communicate through a portal during the resolution process.
According to the MGMA, for now, a party has to download the submitted IDR claim and email it to the non-originating party, potentially burdening smaller practices with manually tracking claims and being administratively challenging Larger number of large practices.
“An interactive platform that tracks existing disputes, contains a clear timeline of the required processes, and acts as a communication platform between all parties involved, is essential to reduce the current burden on disputing parties and ensure that all practices have access to the IDR process, ” MGMA statement.
Edit an existing application
In order for the exercise to return to the IDR form later, the MGMA wants the CMS to add the ability to save applications that can be accessed through the exercise login.
Additionally, MGMA proposes to automatically populate all redundant information (such as dates and contact information) throughout the IDR claim, while creating a feature that allows editing and viewing of saved line items.
Update form fields
Finally, the MGMA asked CMS to adjust the required information to better reflect the information available to different information providers and payers.
Specifically, this means merging or changing the following form fields:
- Add an identifier field that providers and insurance companies can leverage to ensure both parties understand which services are in dispute.
- The use of form fields for entering qualifying payment amounts is optional for providers and facilities.
- Provides an optional Insurance Type form field for providers submitting an IDR Initiation.
In addition to the proposed priority changes, MGMA recommends that CMS also create a timeline for the IDR process, provide additional education and make adjustments to the bulk submission process, and continue engaging with providers and health plans on best practices for submitting claims.
Jay Asser is Associate Editor of HealthLeaders.