Proposed legislation from Rep. Frank Pallone, the Lower Premiums, Faster Payments Act, would replace federal IDR with a payment benchmark for services furnished beginning in 2028. Whatever happens in Congress, IDR is the process in place today — and recent federal rule changes make it more accessible than it has ever been.
The 2026 Federal IDR Operations Final Rule modifies several elements that historically made IDR difficult to scale. As of June 11, 2026, administrative fees have dropped from $115 to $15 per party, per dispute. Beginning January 1, 2027, plans must use standardized claim codes indicating whether the No Surprises Act and Federal IDR apply, with additional payer disclosures to follow once the Federal IDR Registry is live. Enhancements to the IDR Portal are designed to centralize how providers initiate, track and manage disputes.
For revenue cycle leaders, those changes warrant a fresh look at IDR. But easier access to the process doesn't automatically translate into better revenue outcomes.
The opportunity is real, but so is the execution risk.
Federal data, which now captures the entirety of 2025, illustrates both sides of the equation. In 2025, providers, facilities and air ambulance providers prevailed in approximately 85% of Federal IDR payment determinations. At the same time, non-initiating parties challenged eligibility in 42% of initiated disputes, and certified IDR entities ultimately found 19% of disputes ineligible. Those numbers point to an important distinction.
The goal isn't simply to file more disputes. It's to identify and pursue the right claims with the discipline required to convert an eligible underpayment into recovered cash.
IDR is a revenue cycle workflow—not simply an arbitration process.
An IDR opportunity starts well before arbitration and doesn't end when an award is issued.
There are four phases where value can be won or lost:
1. Eligibility identification. Teams need to reliably identify IDR-eligible claims, distinguish federal from state pathways and surface the payer, plan and remittance information required before filing windows close.
2. Open negotiation. This phase establishes the record and timeline and creates an opportunity to resolve a claim before arbitration costs are incurred.
3. IDR arbitration. Getting the claim into the process isn't enough. The provider's reimbursement position must be supported with appropriate evidence, including factors such as patient acuity, complexity and scope of services.
4. Post-award recovery. An award isn't recovered revenue until payment is received, posted and reconciled. Teams also need to identify short or late payments and capture related claims that may become eligible for future recovery.
When these phases operate as isolated tasks, recovery can be lost at the handoffs.
When they operate as one connected workflow, IDR can become a repeatable recovery cadence rather than a series of individual disputes.
Better outcomes require a portfolio mindset.
Underpaid out-of-network claims can have a material impact on a provider's bottom line. The challenge is identifying repeatable patterns across payers, service lines, claim types and reimbursement behavior—and then acting on those patterns with consistent selection, evidence and follow-through.
That means revenue cycle and finance leaders should evaluate IDR as a managed recovery portfolio.
Visibility should extend beyond win rate to eligible and filed volume, federal versus state routing, average lift, fees, recovery timing, payer and service-line concentration, ineligibility and withdrawal rates, net recovery after fees, and award-to-cash reconciliation.
Just as important, those outcomes should feed the next decision.
Patterns in disputes, ineligibility, payment delays and recovery can help refine claim selection, evidence strategy, escalation pathways and pursuit thresholds—and identify recurring issues that may require payer, contracting, documentation or other upstream intervention.
That's where IDR moves beyond recovering an individual claim.
The objective is to improve net recovery while reducing repeatable sources of friction over time.
Start by weighing eligibility against economics.
Not every eligible claim makes financial sense to pursue.
A sustainable IDR strategy considers the eligible opportunity, expected reimbursement lift, cost to capture, time to cash and operating risk.
Lower administrative fees and expanded batching may change the pursuit threshold for recurring, smaller or mid-value disputes. But eligibility confidence, expected lift, payer concentration, batching potential and cost to capture still determine where the strongest opportunities exist.
The objective should be clear: pursue every eligible claim where there's a positive return on investment.
The question for revenue cycle leaders is no longer simply, Do we pursue IDR?
It's: Do we have the visibility, expertise, workflow and capacity to consistently turn the right IDR opportunities into recovered revenue?
Go deeper
Hear more about overlooked revenue opportunities and the operational considerations surrounding IDR in the Vendor Voices conversation with Knowtion Health's Adam Cartabiano. Watch/listen to the conversation →
Then explore the full operating model—from eligibility through award-to-cash—and assess where your organization may have an opportunity to improve IDR recovery. Download The IDR Recovery Gap Playbook →
What is your IDR routing opportunity? The Knowtion team can help you quantify it, then operationalize to start seeing more revenue. Email services@knowtionhealth.com or visit our solutions page to learn more IDR Solution | Knowtion Health.
