Federal officials issued proposed changes to the IDR process Oct. 27 that they said, if finalized, will improve communication between payers, providers and certified IDR entities, create a more efficient dispute resolution process and change the administrative fee structure to improve accessibility.
“The proposed rule does not address the general lack of monitoring and enforcement regarding the qualifying payment amounts (QPA) offered by the carriers,” Washington State Hospital Association Finance Policy Director Andrew Busz said in a Nov. 9 post on the hospital group’s website. “This, along with CMS instructions to IDR entities that give inordinate weight and credibility to the QPAs offered by the carriers has undermined the process.”
Mr. Busz said they are also concerned about the proposal to limit batched claims to 25 claims. The organization plans to comment regarding the proposal by the Jan. 2 deadline.
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