Insights
Insights for provider revenue leaders
Practical, sourced guidance on the dollars hospitals and provider groups leave on the table — federal IDR under the No Surprises Act, rural hospital finance, specialty reimbursement, and the policy shifts that move them.
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Is IDR Worth Pursuing? Weighing the Economics Honestly
Federal IDR can return meaningful out-of-network revenue, but it is not free money. A CFO's framework for the fees, deadlines, and operational load that decide whether a dispute is worth filing.
Read the guide →Am I Eligible for Federal IDR? The 8 Requirements, Explained
A dispute qualifies for federal Independent Dispute Resolution only if it meets all eight statutory criteria. Here is the complete checklist, the timelines, and what most often blocks eligibility.
The 30-Day Open Negotiation Period: The Step You Can't Skip Before IDR
Federal IDR isn't the first move. The No Surprises Act requires a 30-business-day open negotiation period first, and getting its dates wrong is one of the easiest ways to have a dispute blocked at the portal.
The 90-Day Cooling-Off Period: The IDR Rule That Catches Providers Off Guard
After an IDR determination, you generally can't re-file against the same plan for the same item or service for 90 days. Here's what the cooling-off period covers, what it doesn't, and how to plan around it.
State Law or Federal IDR? Why the Wrong Process Sinks Your Claim
Federal IDR doesn't apply when a specified state law governs the dispute. Filing federally on a state-law claim is a fast way to get dismissed. Here's how to tell which process you're in.
Am I Eligible for Federal IDR? The 8 Requirements, Explained
A dispute qualifies for federal Independent Dispute Resolution only if it meets all eight statutory criteria. Here is the complete checklist, the timelines, and what most often blocks eligibility.
Is IDR Worth Pursuing? Weighing the Economics Honestly
Federal IDR can return meaningful out-of-network revenue, but it is not free money. A CFO's framework for the fees, deadlines, and operational load that decide whether a dispute is worth filing.
The QPA Is Not a Cap: What Payers Get Wrong About IDR Pricing
Payers treat the qualifying payment amount as the ceiling for out-of-network pay. After the TMA II rulings, it isn't: the IDR arbiter must weigh all statutory factors and give the QPA no special weight.
Why Hospitals Subsidize Radiologists, and How IDR Can Help Rebalance the Math
Stipends to radiology, anesthesia, and emergency groups are a symptom of out-of-network underpayment. Federal IDR is one lever to recover fair payment and narrow the gap subsidies fill.
Why Are Rural Hospitals Closing, and What Revenue Is Recoverable?
Rural hospitals run on razor-thin margins, and underpaid out-of-network claims are one of the few revenue levers they fully control. A short explainer for rural CFOs.
Why High-Acuity Specialties Leave Out-of-Network Revenue Behind
Emergency medicine, anesthesiology, radiology, and pathology generate large out-of-network volumes, and the most underpaid claims. A short explainer for specialty group leaders.
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