IDR process supports the NSA
Healthcare executives and physician leaders:
If your organization is not systematically using the Independent Dispute Resolution (IDR) process, you may be unintentionally accepting millions in avoidable commercial insurance reimbursement losses.
The No Surprises Act (NSA) established IDR to correct materially deficient out-of-network payments.
This is not an aggressive tactic.
It is a lawful mechanism for payment governance.
However, most organizations fail to operationalize it consistently.
Common reasons include:
• Limited awareness of the process
• Missed 30-day filing deadlines
• Lack of structured escalation protocols
• Underpayments normalized as an unavoidable cost of doing business
The financial impact can be significant.
Consider a conservative scenario:
Average reimbursement shortfall: $8,000 per claim
Disputed claims per month: 15
This equates to:
• $120,000 per month
• $1.44M per year
• $4.3M+ over three years
For large health systems, these losses translate into margin compression.
For private equity-backed platforms, they represent enterprise value erosion.
For independent physician groups, they directly impact physician income and sustainability.
Underpayments rarely appear as a single catastrophic loss.
Instead, they accumulate quietly through unrecovered reimbursement.
The decision to engage the IDR process is not merely operational.
It is a leadership decision about revenue governance.
At Callagy Recovery, our legal team partners with billing companies to manage the IDR process on behalf of healthcare organizations.
Our work is contingency-based, meaning fees apply only to successfully recovered reimbursement.
If you oversee revenue integrity within your organization, it may be worth asking:
Are we actively governing reimbursement,
or unintentionally accepting underpayment?
If you’d like to discuss the process, feel free to message me or schedule a brief conversation here:
https://mprps.squarespacescheduling.com/schedule/19f89de8/appointment/89096499/calendar/4522197
#HealthcareLeadership #RevenueIntegrity #IDR #NoSurprisesAct #Healthcare #IDR #NSA #leadership #purpose #revenuecyclemanagement #revenue