Out of network billing didn't end with the No Surprises Act, but the practices still succeeding at it changed how they operate. What actually changed: patients are now largely shielded from surprise balance billing, and disputes over payment moved from patient collections into a formal arbitration process between the practice and the payer. What didn't change: a well run out of network practice can still be financially viable, if the billing and dispute process is treated as a core operational discipline rather than an afterthought.
The practices still succeeding at this share a pattern. They document thoroughly before a dispute ever starts, they understand how a QPA is calculated well enough to challenge it credibly, and they treat IDR filings as a skill to get good at, not a last resort. The practices that struggled after the NSA were largely the ones still operating on pre NSA assumptions about how disputes get resolved.
Written by John M. Abrahams, MD — board-certified neurosurgeon, founder of New York Brain & Spine Surgery.
Related: Mastering Out-of-Network Billing & the NSA
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