Analysis of No Surprises Act arbitration, payer conduct, reimbursement policy, and the practical decisions that shape provider recovery.
ACEP's message to Congress centers the conduct that pushes claims into arbitration: initial payments, defaults, nominal offers, QPA calculations, and compliance after an award.
Read the Halkovich Law analysisEmergency medicine, radiology, and anesthesiology organizations presented new figures on insurer defaults, nominal offers, and QPA-related concerns. Halkovich Law examines what the data add to the IDR debate.
Read the Halkovich Law analysisThe court rejected an implied private NSA enforcement action, but the binding award and 30-day payment obligation remain. Halkovich Law explains the jurisdictional and practical consequences.
Read the Halkovich Law analysisCMS has opened account creation, with the full filing transition ahead. Halkovich Law explains who must register and what records providers should protect now.
Read the Halkovich Law analysisIn response to Politico's reporting on employer concerns, Halkovich Law examines the evidence needed before assigning premium increases to IDR awards.
Read the Halkovich Law analysisA neutral brief on the proposed Stop Corporate Takeovers of Physicians Act and the ownership, MSO, clinical-control, and contract provisions it would address if enacted.
Read the news briefA source-attributed summary of Paragon Health Institute's findings and its proposed changes for elective and emergency-service disputes.
Read the policy briefSix certified IDR entities received oversight letters requesting operational, ownership, quality-control, and dispute information.
Read the news briefHalkovich Law examines the federal 30-calendar-day payment rule and the records providers should preserve when a final IDR determination remains unpaid.
Read the Halkovich Law analysisPhysio Solutions, LLC, doing business as medlitix, has joined the federal IDR roster. CMS currently lists the organization as not accepting new disputes.
Read the news briefUnitedHealthcare's October reduction is meaningful. Halkovich Law explains why practices still need code-, plan-, state-, and patient-specific proof before changing workflows.
Read the Halkovich Law analysisHalkovich Law examines the reimbursement loss and administrative burden created by recurring downcoding—and the records providers should preserve now.
Read the Halkovich Law analysisHalkovich Law responds to the Fierce Healthcare report with the missing context: reported award errors, health-plan defaults, nominal offers, and the disputed QPA benchmark.
Read the Halkovich Law analysisHear Jeffrey discuss claim eligibility, QPA-based payments, open negotiation, IDR documentation, and the administrative mistakes that can cost providers recovery opportunities.
Listen to the full Q&AHalkovich Law examines an opinion in The Hill about insurer challenges, initial payment offers, IDR outcomes, and award enforcement—then outlines the records providers should preserve.
Read the Halkovich Law analysisA federal appeals court rejected important parts of the methodology used to calculate the qualifying payment amount. Halkovich Law examines the decision's implications for QPA review, negotiation, documentation, and federal IDR strategy.
Read the Halkovich Law analysisHalkovich Law examines New York Times coverage and RevGuard's separate response to Wall Street Journal coverage, then considers the practical implications for claim screening, eligibility, documentation, and enforcement.
Read the Halkovich Law analysis