The Arbitration Process
The NSA is a federal law enacted in 2020 that protects patients from surprise medical bills. The law prohibits balance billing for certain emergency and non-emergency services, particularly when received from out-of-network providers at in-network facilities.
The NSA established a federal Independent Dispute Resolution (IDR) process to resolve disputes between health plans and providers regarding out-of-network payment rates. Through the IDR process, payers and providers can arbitrate payment disputes.
Arbitration Solutions specializes in billing arbitrations, negotiations, and collections.
It is through the IDR process that Arbitration Solutions can provide medical practices with revenue that they never would have expected, without physicians having to do any additional work.
By leveraging specialized expertise and proprietary arbitration software, Arbitration Solutions can boast a 98% success rate in all arbitration disputes.
Our customers are often very surprised by the fees that Arbitration Solutions can collect from the insurance companies for virtually all surgical procedures. Surgeons may bill separately for surgical assistants.
Arbitration Solutions does not disrupt a provider’s current billing and collections arrangement.
Our work begins after the provider has received their standard payment from the insurance company. Arbitration Solutions then starts the arbitration process.
Arbitration Solutions, LLC does not charge any fees unless the provider wins arbitration and the medical practice collects additional funds. Providers are receiving income they were not even aware was available.
The Florida state surprise bill law covers “fully insured” commercial plans (30% of commercial insurance claims). The federal NSA law covers the “self-insured” commercial claims (70% of commercial insurance claims). Arbitration Solutions is able to arbitrate in both state and federal cases.
The NSA does not apply to Medicare, Medicaid, Medigap, and the Children’s Health Insurance Program (CHIP). Private Medicare and Medicaid plans can be arbitrated under state law.
Physicians who previously declined to treat patients due to their “out-of- network” status, can now begin to accept these patients and receive larger payments than for “in-network” patients.
For physicians who were “in-network”, many have realized they would be better off being “out of network”. The revenue from one “out of network” procedure may significantly exceed the revenue of multiple “in-network” procedures.
Our team is comprised of seasoned legal consultants and industry experts with extensive experience in healthcare arbitration, ensuring that physicians receive expert guidance and representation throughout the process.
We prioritize efficiency in arbitration proceedings, minimizing administrative burden and accelerating the resolution of disputes, allowing physicians to focus on delivering exceptional patient care.
We have access to a massive amount of example payments of previous awards to support your claims for maximum reimbursement.
We advocate vigorously on behalf of physicians to secure fair and equitable reimbursement rates, maximizing compensation for out-of-network services rendered.
Our comprehensive understanding of “No Surprises Act” regulations and requirements ensures that arbitration proceedings are conducted in full compliance with relevant guidelines, mitigating risk and ensuring peace of mind for physicians.
If you are an “Out of Network” physician who performs procedures on insured patients, whether in the Emergency Room, on hospitalized patients, or you perform elective procedures with pre-authorization approvals from the insurance company, Arbitration Solutions can substantially increase your revenue.
Step by Step
1. Eligibility
A provider qualifies if they treat an insured patient at an in-network facility, but are themselves out-of-network.
2. Fee Guidance
Arbitration Solutions advises the provider on appropriate fees for frequently used CPT codes which are often significantly higher than the provider’s current fees.
3. Separate Billing
Surgeons may bill separately for surgical assistants (MD, PA, NP, FA, etc.).
4. Billing & Appeals
Providers bill insurers as usual and appeal denials through their current billing service.
5. Claim Submission
After receiving payment, the provider sends Arbitration Solutions the patient’s insurance information, HCFA, EOB, and operative note.
6. Deadline
Claims must be submitted for arbitration within 30 business days of the payment date.
7. Code-by-Code Submission
Arbitration Solutions submits each qualifying CPT code individually.
8. Eligibility Notice
The IDR entity notifies Arbitration Solutions when a submission is eligible.
9. Payment to IDR
The payer must send payment to the IDR entity, including a $115 CMS fee and an IDR fee (typically $400 to $800 which is refunded when the case is won). Payment is typically due within 10 business days.
10. Arbitration
The case proceeds, and Arbitration Solutions is notified of the outcome.
11. Payment Awarded
If the provider wins (98% success rate), the insurer must pay the award within 30 business days.
12. Provider Effort
The process is simple and takes only minutes per CPT code for the provider. Total processing time is usually 3 to 6 months, with a typical provider net cost of $115 per code.
Arbitration Solutions does not charge any fees unless we collect more for you
AFTER your initial insurance payment.