Informal Dispute Resolution

The Federal Affordable Care Act offers Independent Informal Dispute Resolution (IDR) process to nursing homes cited for deficiencies identified by the State of Federal government that leads to the imposition of a civil money penalty (CMP).

The IDR process gives nursing facilities, assisted living facilities, intermediate care facilities, Home, and Community-based Services the opportunity to informally dispute state or federal regulatory survey findings. The IDR recommendations are provided to the state who is ultimately responsible for the outcome of the CPM and for the IDR contract.

An IDR Process is the single opportunity for providers to refute deficiencies or correction order and covers the following:

  • a federal or a state survey
  • a complaint investigation
  • a follow-up survey/revisit
  • a Vulnerable Adult Act investigation (Abuse and Neglect)

PTM is an organization who understands Medicare and Medicaid program requirements and is independent from state government and providers.   PTM’s  contracts with both Medicaid and Medicare have included IDRs, Medicare Quality Improvement processes, Medicare Case Review, Medicaid External Reviews, Nursing Home Quality Improvement grants and corrective action plans for health care plans and providers. PTM’s qualified and experienced staff can quickly and fairly address dispute resolutions.