The No Surprises Act has reshaped how surgical practices handle out-of-network claims, requiring more precise documentation, stricter timelines, and a stronger strategy to secure full reimbursement. Since balance billing is no longer allowed, success now depends on how well you manage and defend each claim. Comprehensive documentation—detailed operative notes, pre- and post-procedure records, and proof of medical necessity—forms the foundation of a defensible submission. Leveraging the NSA’s Independent Dispute Resolution process is crucial, as arbitration often yields significantly higher payments than the initial insurer’s offer. Because the NSA includes rigid deadlines, a reliable tracking system—or a dedicated recovery partner—is critical to avoid forfeiting reimbursement. Many practices also overlook the value of auditing old claims, where years of recoverable revenue may still be eligible for dispute. Collaboration between clinical and billing teams ensures the claims are fully supported, while data analysis helps identify insurer underpayment patterns and build stronger cases. For many providers, partnering with specialists in out-of-network revenue recovery streamlines the process and maximizes financial return. By treating every out-of-network encounter as an opportunity rather than an administrative burden, surgical practices can turn NSA complexity into consistent and meaningful revenue recovery.
source: https://callagyrecovery.com/8-tips-for-surgeons-to-maximize-out-of-network-claims/
Comments
Download this infographic.