Six months after balance billing prohibitions mandated by The No Surprises Act (NSA) took effect, the industry is acclimating to the shifts in surprise medical billing expenses and the implementation of a newly created arbitration process called the Independent Dispute Resolution (IDR) process. The NSA requires that payers and providers negotiate reimbursement for NSA claims if the provider is unhappy with the initial payment. If negotiations and settlement efforts fail, then either party can initiate the IDR process.
These were the key themes discussed in this new podcast from Future Healthcare Today. In this new podcast, experts discuss the complexity of the IDR process and some of the legal challenges it has prompted. The Zelis team of Matthew Albright, Chief Legislative Affairs Officer, Lisa LaMaster, Vice President of Business Solutions, and Tristan Buis, Director of Claims Settlement, joins host, Kevin Tierney, to discuss this topic further.
“The independent dispute resolution, or IDR, process, is really the arbitration part of the reimbursement process… In this process, a third-party arbitrator that has been certified by the Department of Health and Human Services takes a look at the two different reimbursement amounts submitted by the parties. Then, they make a decision about which reimbursement amount is more appropriate based on a number of factors.”
Listen to the full podcast below: