Maintaining RCM Velocity: Why IDR Gateway Readiness Starts Upstream

Ever since it was announced in March, the new IDR Gateway has prompted more questions than answers: 

• When is it rolling out? How long will the existing web forms continue to be active?

• What will it look like? How easy will it be to use?

• What will happen to in-flight disputes?

• Will it have easy integration APIs? Or be compatible with Robotic Process Automation (RPA) bots?

As of right now, we have very few answers: per the September 15th webinar, CMS says the IDR Gateway is in November and the existing web forms are likely to be available until January 15th, assuming timelines don't shift.  But, many critical questions remain unanswered.

While we do have some idea of what the IDR Gateway will and won't do, precious little has been revealed about the Gateway, save that it will require US-based logins and will include a few high-level features. With so many unknowns, it might be tempting to put the IDR Gateway out of mind and focus on more pressing matters.

Even without concrete answers, now is the time to start thinking about transitioning your existing NSA solution to the new IDR Gateway. Otherwise, there is a risk of lost revenue as a bumpy transition can result in missed filing windows and unrecovered revenue.

How to prepare: Managerial

Certain activities, such as detecting dispute candidates in remits, managing the 30-day negotiation clock, and tracking actual cash posting, need to be solved in internal systems regardless of when CMS launches the portal.  This is an excellent time to evaluate each of those things and consider alternate approaches for automation and/or staffing.

Even if you are not currently using software solution(s) for this effort, a critical component is to start mapping out the change management and training plans for your team:

• Keep your team updated on the latest IDR Gateway news as CMS releases it, so they have time to acclimate to the changing process.

• Confirm your staff meet the new regulatory requirements for using the IDR Gateway (namely, that they're US based) so you can begin shuffling around resources sooner rather than later.

• More broadly, make sure your team is aware not just of the CMS changes, but the organizational approach as you develop it. This builds buy-in and will help you have a smoother transition.

If you currently outsource this work, your organization could be held legally liable if they're not adequately compliant with the new rules, so I strongly advise working with your vendor to ensure compliance.

How to prepare: Technical

If you currently automate this process to any level, there's work to be done ahead of time - even with the limited insight we currently have, technical implementation teams can start preparing for the transition. Even though we don't have enough information to build RPA bots or endpoints to interact with the Gateway, we do know any existing technologies you are currently using will have to be switched over, so now is the time to begin preparing your systems:

• Work with your developers to confirm your existing software or process is adequately modular, so pieces can be switched out with ease without disrupting your work stream.

• Address any existing technical debt now, so it doesn't cause unexpected problems down the line as more change is added to accommodate the IDR Gateway. This includes any storage of credentials.

• Make sure that you're keeping a rigorous update schedule, so routine software maintenance or upgrades doesn't cause any hiccups in your transition. 

Why this matters for providers

For many providers, the IDR process is a significant source of recovered revenue. Dragging your feet on your organization's IDR Gateway transition could put that revenue stream at risk; for example, costly delays creating missed milestones lead to losses by default.

For organizations with highly distributed dispute-processing models, the change to an IDR Gateway may prompt decisions around staffing, workflow design, automation, vendor responsibilities, and operational visibility.

Ready or not, the IDR Gateway is coming, and it will significantly impact the entire IDR process. Now is the time to start thinking about how to bring your IDR process into the future.  

Want to continue the discussion and get more customized advice? Apply for our free IDR Gateway Readiness Operational Audit.