March 31, 2005

Change In New Mexico IDR Practice

Until recently, the New Mexico Survey Agency allowed providers to file only the Informal Dispute Resolution request- without your rebuttal information- by the tenth day after receipt of the 2567. The agency then permitted additional time for filing the rebuttal information as long as it was received two weeks prior to a meeting of the Informal Review Committee meeting.

The above described practice, though contrary to the written policy, was allowed until now. Contacts at the DOH have now indicated that the practice has apparently reverted to the written policy which was promulgated on 11-25-03. This policy requires that you file, along with the initial request, all of your IDR rebuttal materials by the 10th day.

It should be noted that the policy does not define what it means by "filing a written request." In the legal world, "filing" generally means placing in the mailbox or having postmarked on the due date. Thus, if you mail a document on the due date, it is considered filed timely. That's the general practice.

However, a contact at DOH has indicated that is not DOH's interpretaion. It's interpretation is that the IDR materials must be received by DOH in Santa Fe by the 10th day. If it is received after the 10th day, it will be considered untimely and will not be considered.

This is unfortunate because it means that facilities located outside Santa Fe will have to mail IDR rebuttal material earlier and will not have the advantage of the full ten days to prepare the material. In the alternative, they may have to fax the materials--although that may be a problem if the rebuttal information is voluminous. Further, the policy does not indicate if fax filings will be accepted.

Regardless, interpreting the policy in this manner does not treat all facility's equally. Facilities located in or near Santa Fe are in a position to hand deliver the materials on the due date. Facilities located elsewhere will not have that advantage.

The only fair way to handle this is to require that IDR requests and rebuttal materials be put in the mail, or given to another carrier, on or before the 10th day. Handling it in this manner gives all facilities the full ten days to prepare the materials.

The contact at DOH also indicated that if an IDR is due on Sunday, but received on Monday, it will be considered untimely--even though none of the DOH employees are on premises to accept delivery on Saturday or Sunday.

Therefore, if your IDR is due on a weekend or holiday, DOH must receive the documentation on the day before the holiday or weekend. Again, this signficantly cuts down your time for preparation. If DOH is not going to have anyone available to accept deliveries on Saturday and Sunday, the due date should be moved to Monday.

Finally, ten days to put together the rebuttal materials is unrealistic in many cases. A sixty page 2567 addressing 15 or 20 patients is difficult to challenge in such a short period of time.

In the meantime, please note that the practice has changed. If you have an attorney or corporate nurse doing your IDR's, it is important that the attorney or corporate nurse receive the 2567 the very day that you receive it.

UPDATE:

Apparently, DOH is reevaluating the above information. We were told that if an IDR rebuttal is due on a weekend, but received the following business day--it will be considered timely.