Posts Tagged ‘IDR’

When the No Surprises Act introduced the Independent Dispute Resolution (IDR) process, it gave hospitals a new path to recover out-of-network revenue. On paper, it looks straightforward: identify eligible claims, submit disputes, and let the process play out. In reality, most organizations are finding that execution is where things fall apart. The real question isn’t…

In today’s healthcare environment, providers face relentless reimbursement pressure — especially for out-of-network (OON) services, where insurers often pay far below expected rates. While the No Surprises Act (NSA) protects patients from unexpected bills, it also created a federal Independent Dispute Resolution (IDR) process that providers can strategically use to recover revenue that might otherwise…

Out-of-network underpayments can create significant revenue leakage for hospitals and health systems. When payer reimbursements fall below reasonable payment expectations, organizations may accept the payment, write off the remaining balance, or attempt to recover additional reimbursement through inconsistent internal follow-up. A structured out-of-network revenue recovery strategy gives hospital finance and revenue cycle leaders a more…

Independent Dispute Resolution (IDR) is a formal process that allows healthcare providers and health plans to resolve certain out-of-network payment disputes without involving the patient. Established under the No Surprises Act, the Federal IDR process provides a structured pathway for resolving eligible reimbursement disputes when providers and payers cannot reach an agreement through open negotiation.…