The new guidance clarifies that, consistent with the decisions in the Texas Medical Association cases, initiating parties may batch eligible services in a single IDR proceeding if they relate to the treatment of similar conditions. However, the agencies do not provide any guidance on what this means in practice, leaving it to IDR entities and disputing parties to navigate this murky requirement. Providers may increase the number of services in batched disputes given the lack of clarity. Although proposed amendments to the IDR rules would limit batched disputes to 25 services, there is currently no limit on the number of services that may be batched in IDR. High-volume batched disputes could dramatically increase the burden on payors to research and assert eligibility objections within the requisite three-business-day period following IDR initiation.
While the IDR portal remains closed to batched disputes and air ambulance disputes, the agencies expect to reopen it “as soon as possible.” Once they do:
- Parties will have 20 business days to initiate batched disputes and air ambulance disputes arising since August 3, 2023.
- Non-initiating parties will have 10 business days to assert eligibility objections to any disputes filed under this extended deadline.
- Pending batched disputes already determined to be eligible for IDR may not be amended to include additional services in light of the new rule, and batched disputes previously dismissed as ineligible may not be resubmitted.
- For batched disputes filed before August 3, 2023, but where an eligibility determination has not been made, IDR entities must apply the broader “similar condition” standard.
- If the IDR entity still determines the dispute is ineligible, the initiating party can amend and re-file the dispute within 10 business days of the eligibility determination.
- Additional extensions to IDR deadlines may be granted upon request.
- Additionally, on November 29, 2023, the tri-agencies announced a temporary timeline extension, namely that disputing parties will have 10 business days to select a certified IDR entity for all disputes through January 16, 2024.
Newsflash 2023-268