Published in HFMA First Illinois Chapter Newsletter, June 2025 | Author: Liana Hamilton, General Manager, Payment Variance Recovery, Aspirion
Since the No Surprises Act (NSA) took effect in January 2022, hospital revenue cycle leaders have faced significant challenges in managing out-of-network (OON) reimbursements. While the legislation protects patients from unexpected medical bills, it has created financial strain for healthcare providers, leading to payment delays, operational hurdles, and resource depletion. The claims backlog is a major issue, with over 490,000 NSA-related disputes filed between April 2022 and June 2023, 61% of which remain unresolved. This backlog disrupts cash flow and adds pressure to already stretched revenue cycle teams.
Despite these challenges, hospitals are winning 77% of Independent Dispute Resolution (IDR) cases, highlighting widespread underpayment issues. However, the regulatory environment remains complex, with recent court rulings and pending NSA provisions like Advanced Explanation of Benefits (AEOB) adding further uncertainty.
Advanced technology, particularly AI, is proving to be a game-changer in OON revenue management. AI-driven claim identification prioritizes high-value claims, while automated deadline management ensures timely action during the 30-day negotiation period. Tailored payer strategies, systematic IDR outcome analysis, and strategic resource allocation further enhance recovery rates and operational efficiency.
To succeed in this evolving landscape, hospitals must move beyond compliance and adopt proactive, tech-powered strategies. Leveraging AI and automation not only streamlines OON claims management but also improves financial outcomes. By staying agile and strategic, healthcare organizations can navigate regulatory complexities, maximize OON revenue, and mitigate revenue loss in the NSA era.
Want to learn how advanced technology can help you navigate the complexities of the No Surprises Act and maximize out-of-network revenue? Dive into the full article for actionable strategies, expert insights, and proven approaches to streamline OON claims management. Discover how AI and automation can transform your revenue cycle and position your organization for financial success in this challenging regulatory environment.
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