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  • 1.  Federal IDR Process

    Posted 08-24-2022 16:42
    Curious if anyone is using the Federal IDR process for OON claims.
    Looks like the rules for batching claims were written by someone from the insurance company lobby.
    • 30 business days after payment AND
    • batched in buckets of 30 business days of claims
    • filed in 4 days after the end of the open negotiation period

    Thought the state rules were fun but the Federal rules take it to a whole new level.


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    Douglas G. Kraus, CPA
    Chief Financial Officer
    South Texas Radiology Group, P.A.
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  • 2.  RE: Federal IDR Process

    Posted 08-24-2022 17:24
    Hi Doug

    Also one code per batch.

    We went out of network with our largest payor July 1, and we're working through the open negotiation period now...or should I say non-negotiation period because the payor has not negotiated.  Barring a change of attitude, we'll be submitting our first batches to the IDR mid-September.

    So far, it's been fairly manageable.  The most challenging part has been pulling claim numbers for the open negotiation notices, since our billing company doesn't currently have a way to pull those other than manually.

    I think you do have to strategize a bit about how you build your batches, taking account of the risk of paying the IDR fee if you lose.  I did some smaller/shorter period batches first to test the waters, be sure we have the right pitch, assess which IDR's may be provider friendly, and also be a burr in the saddle of the insurance company who has to respond to them...in hopes of brining them back to the negotiating table.

    Once you get to the cooling off period post-IDR, then you can do 90 calendar day batches.

    Obviously we're doing a significant volume of claims.  I don't think it would be worth using the IDR process if the dollars are not enough to warrant a bet on the IDR process, but you might be able to use the open negotiation notice to try to get the payor to negotiate by opening the door to IDR without actually going there.

    Dave

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    David Smith FACMPE
    Executive Director
    United Imaging Consultants
    Mission KS
    (785) 393-8387
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    Original Message


  • 3.  RE: Federal IDR Process

    Posted 08-25-2022 09:01
    Dave, thanks for the input and yes, agree also batched by CPT.
    I had to create a flowchart to make sure i understood all the various timelines contained in constructing a "batch".
    And to then understand when the cooling off period came into play.

    i will likely do the same, i.e. send some smaller batches to test the waters.

    let's keep in touch off line as we both work our way through the process.

    was just amazing to me at how complicated they made the rules - Texas arbitration is much easier in my mind than all the garbage they through in on how to "batch" a set of claims.

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    Douglas G. Kraus, CPA
    Chief Financial Officer
    South Texas Radiology Group, P.A.
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    Original Message


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