10 Questions Every Radiology Board Should Ask About IDR
The No Surprises Act’s federal Independent Dispute Resolution (IDR) process gives physician groups a path to fair payment for out-of-network services. Many boards know their practice “does IDR” — few know whether it produces cash. These ten questions help you find out.
Summary
A well-run IDR program should be able to report eligible volume, submission rate, deadline compliance, payer-specific outcomes, award-to-cash realization, time to cash and net ROI. If your current process can’t answer these, revenue is likely being left behind.
The 10 questions
- How many of our claims are eligible for federal IDR?
Ask for the volume of out-of-network claims that met eligibility criteria in the last 12 months — and how that number was determined. - How many eligible claims did we actually submit?
The gap between eligible and submitted is often the largest single source of missed IDR revenue. - Are we meeting every statutory deadline?
Open negotiation, initiation and offer windows are fixed. Ask how deadlines are tracked and how many claims were lost to timing. - What is our win rate — and against which payers?
A blended win rate can hide payer-specific problems. Ask for results by payer. - What percentage of awards became cash?
An award is not a payment. Award-to-cash realization is the metric that matters to the practice. - How long does it take to collect an award?
Time to cash affects working capital and shows whether payer follow-up is happening. - What happens when a payer doesn’t pay an award?
Ask who follows up, how often, and how unpaid awards are escalated. - How do our results compare with CMS benchmarks?
CMS publishes Federal IDR data. Your program should be measured against it. - Is IDR data informing our payer contract strategy?
IDR outcomes reveal payer behavior. That intelligence should feed negotiations. - What is the net ROI of our IDR program?
Ask for incremental cash collected net of all costs — the single number a board should see.
What to do next
If you can’t answer most of these today, start with an IDR Opportunity Review. Polarity works alongside your current biller to quantify eligible volume and recovery potential.
This content is educational and is not legal advice. Regulatory requirements change; consult primary sources and counsel.