CollectionPro, a specialist in Independent Dispute Resolution (IDR) and out-of-network (OON) collections, has announced an expansion of its recovery services tailored for complex medical specialties. The firm, which has handled over 10,000 cases, reports a 92% win rate in arbitrations under the No Surprises Act (NSA), significantly above the industry average. This performance is achieved through proprietary data and specialty-specific arguments that counter unfair payer benchmarks.
Since the NSA's implementation, healthcare providers have faced increased administrative complexity and underpayments from insurers. CollectionPro addresses this by focusing exclusively on OON claim recovery, providing legal and analytical scrutiny for each case. According to David Nissanoff, CollectionPro's strategic leader, the NSA was designed to protect patients, not to allow insurers to systematically underpay specialized providers. The firm acts as a legal and operational backbone, ensuring providers receive compensation reflecting their expertise.
A key barrier to IDR has been the high upfront costs, often exceeding $1,200 per dispute. CollectionPro eliminates this by operating on a pure contingency model, covering all administrative and arbitration fees. Providers pay only a 10% success fee on the gross award if the claim is won. This structure aligns the firm's incentives with the provider's, turning a costly administrative burden into a predictable revenue stream.
CollectionPro's approach includes customized pricing strategies that go beyond basic Medicare multiples to reflect true market rates. The team navigates federal NSA rules and state-specific laws, such as those in New Jersey and California, with in-house legal expertise. If an insurer fails to pay a won award, CollectionPro pursues enforcement via CMS reporting and legal action. The firm also assists providers in identifying specific CPT codes and facility settings that qualify for maximum recovery, including places of service 21, 22, 23, and 24.
Through a secure portal, practices gain transparency into Explanation of Benefits and patient details. CollectionPro manages the entire dispute lifecycle: claim analysis for IDR eligibility, mandatory 30-day open negotiation with payers, arbitration management with optimal IDR entity selection, and real-time status updates via an integrated dashboard. Additionally, the firm specializes in recovering aged receivables, often re-filing claims 12 to 36 months old that were previously written off, significantly impacting year-end revenue.
For more information, visit CollectionPro's website.
