IDR Data
CMS PUF data · 2023 Q1–2025 Q4

Federal IDR outcomes: Hospitals and facilities in Virginia

In 2023 Q1–2025 Q4, the provider or facility offer prevailed in 66.9% of 130 determined Federal IDR dispute line items for hospitals and facilities in Virginia. The median prevailing offer was 2.89x the QPA (25th–75th percentile 1.83x–5.04x; n = 129).

Determined line items

130

2023 Q1–2025 Q4 · 0 split decisions excluded

Provider win rate

66.9%

n = 130 · 2023 Q1–2025 Q4

Median payment vs QPA

2.89x

middle half 1.83x–5.04x · n = 129 · 2023 Q1–2025 Q4

Median days to decision

–

not pooled across years (CMS changed the definition in 2025)

Dollar amounts are not shown for specialty groups: the CMS QPA and Offers file, the only source of dollar figures, has no specialty field. See methodology.

By period

PeriodLine itemsWin %Median ×QPA25th–75thRatio nMedian days
2025 Q1–Q4Fewer than 30 determined line items; not shown.
2024 Q1–Q49267.4%3.35x2.10x–5.48x9194
2023 Q1–Q4Fewer than 30 determined line items; not shown.
2023 Q1–2025 Q413066.9%2.89x1.83x–5.04x129not pooled

Line items = determined dispute line items (n). Win rate excludes split decisions and includes default decisions. Ratio n = line items reporting a payment-to-QPA ratio. Days are business days as reported by CMS (2023–2024: from IDR entity assignment; 2025: from initiation) and are never pooled.

Most disputed CPT codes

No row has 30 or more determined line items in 2025 Q1–Q4.

Related: all specialties in Virginia · Hospitals and facilities in all states

FAQ

What is the Federal IDR provider win rate for hospitals and facilities in Virginia?

In 2023 Q1–2025 Q4, the provider or facility offer was selected in 66.9% of 130 determined dispute line items for hospitals and facilities in Virginia. Split decisions are excluded from the denominator and default decisions are included. Withdrawn, settled and ineligible disputes are not in the CMS data.

How do Federal IDR payments compare with the QPA for hospitals and facilities in Virginia?

In 2023 Q1–2025 Q4, the median prevailing offer was 2.89x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.83x to 5.04x (n = 129 line items). This uses the CMS field Prevailing Party Offer as % of QPA, where 1.00x equals the QPA.

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