DOL, HHS, and IRS Issue Report Showing High Demand for Surprise Billing IDR Process

April 11, 2023
Hall Benefits Law, LLC

The U.S. Department of Labor (DOL), Health and Human Services (HHS), and Internal Revenue Service (IRS) have issued an initial joint report on the Independent Dispute Resolution (IDR) process containing two quarters of data from April 15 to September 30, 2022. Issuance of this report was delayed by the unexpectedly large volume of disputes submitted through the IDR portal, which required significant manual processing for reporting purposes.

The No Surprises Act, a part of the Consolidated Appropriations Act, 2021 (CAA, 2021), and its regulations created the IDR to resolve disputes over payment rates between out-of-network providers, insurers, and similar entities. The report draws on data from certified IDR entities and the HHS federal IDR portal and concludes a high demand for the IDR process.

The report shows that disputing parties initiated over 90,000 disputes through the IDR portal in the applicable two quarters. Only about 23,000 disputes closed during that same time. Over two-thirds of the disputes related to emergency and non-emergency services closed due to ineligibility for the federal IDR process. Almost half of the disputes related to air ambulance services were ineligible.

The data contained in the report also shows that the parties initiated 60% of the disputes in Texas, Florida, Georgia, Tennessee, and North Carolina, even though Texas, Florida, and Georgia have state processes that apply to payment disputes of certain items and services. The most common types of disputes, based on Current Procedural Terminology (CPT) codes, include emergency department service codes (66%), radiology codes (9%), and anesthesia codes (7%).

HBL has experience in all areas of benefits and employment law, offering a comprehensive solution to all your business benefits and HR/employment needs. We help ensure you are in compliance with the complex requirements of ERISA and the IRS code, as well as those laws that impact you and your employees. Together, we reduce your exposure to potential legal or financial penalties. Learn more by calling 470-571-1007.

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Hall Benefits Law, LLC

HBL offers employers comprehensive legal guidance on benefits in mergers and acquisitions, Employee Stock Ownership Plans (ESOPs), executive compensation, health and welfare benefits, healthcare reform, and retirement plans. We counsel a wide spectrum of clients including small, mid-sized, and large companies, 401(k) investment advisors, health insurance brokers, accountants, attorneys, and HR consultants, just to name a few. HBL is passionate about advising clients, and we are dedicated to our mission: to provide comprehensive, personalized, and practical ERISA and benefits legal solutions that exceed client expectations.

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