IDR process financially unfeasible for radiologists

The independent dispute resolution (IDR) process would be financially impractical for many out-of-network claims for radiologists, according to research published January 17 in the American Journal of Roentgenology. A team led by Eric Christensen, PhD, from the Neiman Health Policy Institute in Reston, VA, found in its study of this part of the No Surprises Act that the potential balance payment would be more than 2024 IDR fees for between 32% and 55% of out-of-network claims for radiologists. This means that payment would exceed the expected breakeven point based on maximal recovery of the full difference. “Lack of financial viability for the IDR process limits clinicians’ opportunities to dispute payer-determined payments and potentially undermines their bargaining power in insurer contract negotiations,” Christensen and co-authors wrote. The federal No Surprises Act aims to eliminate surprise medical billing for out-of-network care for circumstances outside the control of patients. Part of the act is the IDR process, which is intended to settle clinician-payer payment disputes for out-of-network care. The Christensen team studied the fraction of out-of-network claims that radiologists and other hospital-based specialists can expect to at least break even with when payer-determined payments are challenged through the IDR process. Its goal was to find out whether IDR process has financial viability. The researchers gathered claims data from a national commercial d...
Source: AuntMinnie.com Headlines - Category: Radiology Authors: Tags: Practice Management Economics Source Type: news