Medical Revenue Recovery Support for Billing Managers
Callagy Recovery works alongside billing managers to recover money from underpaid out-of-network claims. We handle insurer negotiations and the entire Independent Dispute Resolution (IDR) process. We take over the most time-consuming and complex parts of medical revenue recovery, so you and your team can focus on day-to-day billing operations.
Why Billing Managers Choose Callagy Recovery for Medical Revenue Recovery Support?
- Recover 5x to 15x the insurer’s initial payment.
- Recovered over $1 billion for surgeons.
- Win 94% of our federal IDR cases.
- Recover money from claims that have already been paid.
- Fit into your existing billing workflow.
- Cover all upfront fees.
- Only charge a 20% contingency fee if we win.
- Have over 27 years of experience recovering out-of-network insurance underpayments.
- Backed by Callagy Law, so we understand federal and state regulations.
- Move quickly to meet strict IDR deadlines.
What Is Medical Revenue Recovery for Billing Managers?
Medical revenue recovery for billing managers is the process of recovering additional reimbursement from underpaid out-of-network claims. It involves:
- Identifying underpaid claims eligible for additional reimbursement.
- Negotiating with insurers for higher payments.
- Using the federal Independent Dispute Resolution (IDR) process to challenge low payments.
Which Claims Can Billing Managers Recover Additional Reimbursement For?
- Out-of-network emergency claims, including emergency surgery.
- Out-of-network post-stabilization claims protected under the No Surprises Act.
- Certain non-emergency out-of-network claims for hospital-based specialists, such as neurosurgeons, orthopedic surgeons, plastic surgeons, anesthesiologists, assistant surgeons, radiologists, pathologists, and neonatologists.
- Certain out-of-network surgical claims performed at in-network hospitals or ambulatory surgical centers when balance billing is prohibited.
- Out-of-network air ambulance claims.
Not every out-of-network claim qualifies for additional reimbursement through the IDR process. Eligibility depends on the type of service provided, the facility, the patient’s health plan, whether federal or state law governs the claim, and other requirements under the No Surprises Act.
How Much Additional Reimbursement Can Billing Managers Recover?
Billing managers can recover between $8,000 and $83,000 in additional reimbursement. The amount recovered depends on the claim, insurer, medical specialty, and evidence supporting the case. Here are the average amounts Callagy Recovery has recovered for different surgeon specialties.
Specialty | Average Amount Recovered Through IDR |
|---|---|
Neurosurgeons | $83,120.09 |
Orthopedic Surgeons | $41,580.79 |
Plastic Surgeon | $31,828.64 |
Hand Surgeon | $13,121.74 |
General surgeon | $8,278.42 |
Why Do Billing Managers Need Medical Revenue Recovery Support?
Billing managers need medical revenue recovery support because it requires specialized expertise and resources beyond routine billing operations, including:
- Qualifying Payment Amount (QPA) and reimbursement benchmark analysis.
- Federal Independent Dispute Resolution (IDR) expertise.
- Strict filing deadline management.
- No Surprises Act (NSA) compliance.
Most billing teams aren't built to handle this level of complexity. They’re focused on claim submission, denial management, payment posting, and accounts receivable. As a result, many billing managers choose to partner with specialists for medical revenue recovery.
What Challenges Do Billing Managers Face When Recovering Underpaid Out-Of-Network Claims?
- Recovering underpaid claims takes time. Reviewing claims, gathering documents, preparing IDR cases, and communicating with insurers can overwhelm an already busy billing team.
- Knowing which claims to pursue isn't always easy. Billing managers must decide which underpaid claims are worth pursuing based on their recovery potential.
- Building a strong case requires extensive documentation. Your team must gather medical records, EOBs, payment records, reimbursement benchmarks, and other evidence to support higher payments.
- Negotiating with insurers is difficult. Insurers know how to dispute higher reimbursement requests, making it hard to recover the full amount owed.
- Strict filing deadlines leave little room for error. Billing managers must closely monitor every claim so they don’t miss opportunities to recover additional reimbursement.
What Can Billing Managers Expect When Working With Callagy Recovery?
- Send us underpaid out-of-network claims, along with EOBs, claim forms, and operative reports.
- Our team reviews each claim to confirm eligibility, identify filing deadlines, and estimate the potential recovery amount.
- We handle insurer negotiations, prepare and file the IDR case when appropriate, submit supporting evidence, and represent the claim throughout the dispute.
- Monitor claim status anytime through our secure portal and receive updates from your dedicated account manager.
- If we win the IDR case, the insurer sends the additional reimbursement to your practice.
- We cover all upfront medical revenue recovery costs and only collect a 20% contingency fee from the additional reimbursement we recover.
Callagy Recovery works alongside your billing team to manage the entire medical revenue recovery process, so your team can stay focused on claims, payments, and other daily responsibilities.
Why Are Correctly Billed Claims Still Underpaid?
Correctly billed claims are still underpaid because accurate billing doesn't always lead to accurate reimbursement. After an out-of-network claim is submitted, the insurance company applies its own payment policies, reimbursement methodologies, medical necessity reviews, and claim evaluations to determine how much it will pay. These are just some of the many reasons medical claims are underpaid. As a result, the final payment may be much lower than the surgeon's billed charges, even when the claim contains the correct codes and supporting documentation.
How Does the No Surprises Act Affect Billing Managers?
The No Surprises Act (NSA) affects billing managers by shifting payment responsibility for underpaid out-of-network claims from patients to insurers. Before the law took effect in 2022, billing managers could often recover unpaid balances directly from patients through balance billing. Today, the law protects patients from unexpected medical bills.
The NSA also established the Qualifying Payment Amount (QPA), which is the median in-network contracted rate for the same or similar procedure in an area. Insurers often use the QPA as the basis for their initial payment on out-of-network claims. As a result, insurers may pay far less than the surgeon billed. Sometimes, they pay only 3% to 10% of the billed charges.
To challenge these low payments, the law added the Independent Dispute Resolution (IDR) process. Through IDR, billing managers can challenge low insurer payments and ask a certified arbitrator to determine a fair reimbursement for the surgeon's services.
How Can Billing Managers Measure the Success of Medical Revenue Recovery?
Billing managers can measure the success of medical revenue recovery by tracking these performance metrics:
- Additional reimbursement recovered. The total amount of extra revenue recovered from underpaid out-of-network claims.
- Recovery rate on eligible claims. The percentage of eligible claims that result in additional reimbursement.
- Average reimbursement per claim. The average amount recovered for each successful claim.
- IDR success rate. The percentage of IDR cases that result in a favorable decision for the surgeon.
- Return on investment (ROI). The additional revenue recovered compared to the cost of medical revenue recovery.
- Reduction in revenue lost to underpaid claims. The amount of revenue that is no longer lost because underpaid claims are successfully challenged.
Together, these metrics show whether medical revenue recovery is generating meaningful financial value for the practice.
How Does Medical Revenue Recovery Improve Cash Flow?
Medical revenue recovery improves cash flow by recovering money that would otherwise remain with insurance companies.
For billing managers, this helps:
- Improve collections.
- Reduce revenue lost to underpaid claims.
- Demonstrate the financial impact of billing operations.
For the practice, this provides more predictable revenue to:
- Cover payroll and operating expenses.
- Invest in new equipment or technology.
- Hire additional staff.
- Improve long-term financial stability.
What Are the Federal IDR Deadlines Billing Managers Must Know?
- 30 business days after the insurer issues the initial payment or denial to complete the mandatory open negotiation period with the insurer.
- 4 business days after the negotiation period ends to initiate the federal IDR process.
- 10 business days for both parties to select a certified IDR entity to work on the case. If you can’t agree, the federal government selects one.
- 10 business days after the IDR entity is selected to submit your final payment offers and supporting documents.
- 30 business days for the certified IDR entity to review the case and issue a binding payment decision.
- 30 calendar days after the IDR decision for the losing party to pay the additional reimbursement (or the prevailing offer amount).
Missing any one of these deadlines can permanently eliminate your opportunity to recover additional reimbursement for an otherwise eligible claim. Callagy Recovery tracks every federal IDR deadline for you, so you don't miss the opportunity to recover additional reimbursement. Our team monitors each claim from start to finish, manages every filing requirement, and submits documents on time.
Start Recovering Additional Reimbursement Before IDR Deadlines Expire!
Every day an eligible underpaid claim goes unchallenged is another day your practice leaves earned revenue with the insurance company. After all the work your billing team puts into submitting accurate claims, it's frustrating to see insurers pay far less than they should. It's even more frustrating to lose the opportunity to recover that money because a federal IDR deadline has passed.
Don't let those claims go to waste. Callagy Recovery works with your billing team to identify eligible claims, track every federal IDR deadline, negotiate with insurers, and manage the entire recovery process. Schedule your free claim assessment today and find out how much additional reimbursement your practice may still be able to recover before federal IDR deadlines expire.
Medical Revenue Recovery Support for Billing Managers FAQs
Yes, billing managers can handle medical revenue recovery in-house. However, they usually don’t have the knowledge or time to go through the whole process. Medical revenue recovery requires legal expertise, federal arbitration knowledge, and strict deadline management. Most billing teams are built for volume processing, not complex legal disputes. That’s why it’s better to partner with Callagy Recovery.
Federal IDR costs billing managers around $215 to $855 per dispute. Here’s a cost breakdown:
- Federal IDR administrative fee per party - $15
- Certified IDR entity fee for a single dispute - $200 to $840
- Certified IDR entity fee for batched disputes - $268 to $1,173
- Staff costs - Typically 5-15+ hours per dispute
- Legal or consulting fees - Varies
Callagy Recovery pays all those upfront costs. And we only ask for a 20% contingency fee if we recover money. So there’s zero risk working with us.
No, medical revenue recovery support won’t disrupt your current billing operations. Callagy Recovery works as an extension to your team. So the team can continue managing daily operations without any additional burden.
Billing managers can expect additional reimbursement within approximately 4 to 6 months after the federal IDR process begins. The exact timeline depends on the complexity of the claim and the time required to complete the federal IDR process. Once a payment decision is issued, the insurer generally has 30 calendar days to send the additional reimbursement.
Yes, billing managers can submit multiple underpaid out-of-network claims at once. Similar claims may be batched into a single IDR dispute instead of filing each claim separately. To qualify for batching, the claims generally must involve:
- The same surgeon or surgical practice
- The same insurer
- The same or related service codes
If the claims don't qualify or don’t meet the federal requirements for batching, they must be filed as separate IDR disputes.
Yes, your billing team will receive updates throughout the medical revenue recovery process. Callagy Recovery offers full transparency through real-time claim tracking in our portal. Billing managers can check the status anytime without having to contact us.
Yes, medical revenue recovery support is available to billing managers in every state. Our Callagy Recovery team knows when to use federal IDR and when applicable state payment dispute laws apply. This way, we make sure that each underpaid out-of-network claim is filed correctly.