ACR Offers Recommendations for Addressing 'Cost-Prohibitive' IDR Process in Radiology


Noting the significant administrative fees for the Independent Dispute Resolution (IDR) process of the No Surprises Act and onerous restrictions that have led to a nearly “non-existent” use of batching of disputed claims in radiology, the American College of Radiology (ACR) has sent formal recommendations to the United States Departments of Health and Human Services, Labor, and Treasury for addressing these issues.

In a recent letter sent to multiple governmental departments, the American College of Radiology (ACR) outlined key recommendations for addressing an array of ongoing challenges and costs for radiologists in complying with the Independent Dispute Resolution (IDR) process of the No Surprises Act.

Citing multiple barriers and “unnecessary inefficiencies” that limit radiologist access to the IDR process for disputed claims, William T. Thorwarth, Jr., M.D., F.A.C.R., the chief executive officer of the ACR, noted a variety of challenges in a January 19 letter sent to the heads of the United States Departments of Health and Human Services, Labor, and Treasury.

Dr. Thorwarth said there was a lack of “proper notice and comment” about recent substantial increases in IDR administrative fees (increasing from $50 to $350) and Independent Dispute Resolution Entity (IDRE) fees (increasing from an upper range of $670 to more than $1,200). In one of the recommendations of the letter, Dr. Thorwarth emphasized the ACR has called for immediate rescinding of these fee increases that have made it “nearly impossible” for radiologists to participate in the IDR process.

“Most radiology claims are for less than $50 with the vast majority below $100. Almost none are $350 or more,” maintained Dr. Thorwarth. “Thus, without batching, radiology cannot access IDR in a cost-efficient manner.”

(Editor’s note: For related content, see “Challenging the IDR Process of the No Surprises Act” and “Federal Judge Vacates IDR Provisions of the No Surprises Act.”)

In another recommendation, the ACR has called for a modified approach to batching of disputed claims that would allow submission of disputed items and services under the same category of service codes as opposed to the current standard of limiting batch submission to the same service code.

The current approach for batching of disputed claims is restrictive to the point where it has become “almost non-existent” for radiologists with a batch amounting to two disputed charges on average, according to Dr. Thorwarth. He noted that one radiologist recently determined that 9,238 separate IDR dispute submissions would be required for 18,123 IDR-qualified charges (for one payor and one tax identification number over a 30-business day service period).

“Smaller batch sizes necessitate submission of a larger number of disputes, which impose significant administrative costs and greater IDR fees,” pointed out Dr. Thorwarth. “This is not the robust batching process that Congress intended, and we do not believe it reflects the type of batching process the (U.S. government departments) aim to achieve.”

The ACR also asked for radiologists to be allowed to batch IDR-qualified items and services within a 90-day payment window as opposed to the current window of 30 business days of service.

The current backlog with review of claims submitted for the IDR process has led to payment delays of approximately 220 days, according to Dr. Thorwarth, who added that IDR fees are held in escrow for months while radiologists await decisions of submitted claims. He cited the examples of two radiologists who paid more than $290,300 and $193,000, respectively, in IDRE fees in 2022 for submission claims that haven’t been resolved.

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