INTRODUCTION
The No Surprises Act (NSA) took effect on January 2022. It aims to protect patients from any surprise bills by limiting the cost sharing in out-of-network scenarios and uses the Qualifying Payment Amount (QPA) as the point of reference for payments to be made in such cases.
In most cases, the QPA offered by the payer falls way below the provider’s billed amount. If both the parties (provider and payer) fail to reach a consensus within the initial 30-day negotiation period, the provider can initiate an Independent Dispute Resolution (IDR) through an authorized IDR entity (IDRE).
The IDR is a “baseball-style” arbitration process with the arbitrator finally choosing one of the final offers of reimbursement which gets submitted by either the provider or the payer, with the decision of the arbitrator as final and binding.
HOW WE CAN HELP
OON claims are common in the lives of many healthcare specialists. But most fail to collect from them satisfactorily. Payers often impose severe limitations on out-of-network payments – sometimes to a very small fraction of billed charges – using a variety of tactics.
The heart of the matter is, accepting the payer’s initial offer (usually based on in-network median rates), without negotiating or opting for IDR arbitration, leads to severe underpayments.
Why should you settle for anything less than what you rightfully deserve?
We are here to help you. With our decades of expertise in navigating payer strategies, SunKnowledge collaborates with you to optimize out-of-network payments and negotiate higher reimbursements for better outcomes.
WHAT WE DO
If you are struggling with out-of-network claims, consistently failing to collect the reimbursement you expect (and deserve!), and feeling confused over how to turn things in your favor, you are at the right place!
We provide comprehensive assistance to providers burdened with OON claims and ensure the best outcomes for them.
Our end-to-end support includes:
- Analyzing the OON bill and estimating collectable amount
- Advising on billing/coding modifications for the maximum reimbursement
- Closely coordinating with the provider during the initial negotiation
- Initiating the IDR process and following up on the outcome
- Preparing and submitting all required documentation
- Remitting the final arbitrated amount to your account
SPECIALTIES WE SERVE
Our services cover almost every out-of-network specialist who has provided a service to a patient in an in-network facility, is dissatisfied with the payer’s offer, and is eligible to apply for IDR arbitration under the NSA.
Some of the typical specialists we serve are:
Emergency and Trauma Care Specialists
- Emergency Medicine Physicians (ER Doctors)
- Trauma Surgeons / General Surgeons
- Cardiologists
- Neurologists
- Neurosurgeons
- Obstetrician-Gynecologists
Ancillary and Hospital-Based Specialists
- Anesthesiologists
- Radiologists
- Pathologists
- Neonatologists
- Hospitalists
- Intensivists
- Assistant Surgeons
Other On-Call Specialty Consultants
- Orthopedic Surgeons
- Otolaryngologists (ENTs)
- Plastic and Reconstructive Surgeons
- Urologists
- Ophthalmologists
- Psychiatrists / Behavioral Health Specialists
- Vascular Surgeons
Other Service Providers
- Air Ambulance Service Providers
WHY CHOOSE US?
Since 2007, we have been providing 100% HIPAA compliant end-to-end Revenue Cycle Management (RCM) solutions with tremendous success. We have helped our clients – located across the U.S. and belonging to over 40 specialties – collect billions over the years.
We are among the very few RCM companies operating today with direct experience in working for payers (in claims adjudication and provider credentialing).
We excel in managing denials and collecting from Accounts Receivable (A/R).
With SunKnowledge, you are always assured of:
- Full expertise in NSA legislation and IDR process
- Coders with CPC* and CCS** certification
- Top-notch legal assistance for the best outcomes
- 99% accuracy, fastest turnaround, highest productivity
- Multi-payer expertise (both private and public)
- Lowest cost, with no binding contracts
- Best references and countless testimonials
* Certified Professional Coder
** Certified Coding Specialist
GET STARTED TODAY!
Don’t let payers put a cap on your reimbursements!
Leverage the SunKnowledge expertise in collecting from out-of-network claims and uncover thousands of dollars in new revenue by identifying underpayments denials to be negotiated or appealed.
With us by your side, you are always sure of winning.
Schedule a free consultation today.