CollectionPro, a specialist in Independent Dispute Resolution (IDR) and out-of-network (OON) collections, announced an expansion of its recovery services for healthcare providers. The firm targets complex medical specialties such as surgery, orthopedics, and interventional pain management, which have faced financial challenges under the No Surprises Act (NSA). By focusing exclusively on IDR cases, CollectionPro aims to recover fair market value for specialized medical services.
Since the NSA's implementation, healthcare managers have struggled with administrative complexities, including underpayments and missed filing deadlines. CollectionPro addresses these issues by providing legal and analytical scrutiny for each case. Under the leadership of David Nissanoff, the firm has handled over 10,000 cases with a 92% win rate, significantly higher than the industry average. This success is attributed to proprietary data and specialty-specific arguments that counter unfair payer benchmarks. "The No Surprises Act was intended to protect patients, but it should not be used by insurers to systematically underpay specialized providers," said Nissanoff.
A major barrier to pursuing IDR claims is the high cost of arbitration, which can exceed $1,200 per dispute. CollectionPro eliminates these upfront fees by operating on a pure contingency model. The firm fronts all administrative and arbitration costs, charging a 10% success fee on the gross award only if the provider wins. This structure reduces financial risk for practices and aligns incentives with the provider's goals.
CollectionPro's approach includes customized pricing strategies that move 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 state-licensed lawyers. If an insurer fails to pay a won award, CollectionPro pursues enforcement via CMS reporting and legal follow-up. The firm also assists providers in identifying specific CPT codes and facility settings (places of service 21, 22, 23, and 24) that qualify for maximum recovery.
Through a secure portal, practices can track Explanation of Benefits (EOB) and patient details. Once OON claims are submitted, CollectionPro manages the entire dispute lifecycle, including claim analysis, open negotiation during the mandatory 30-day window, arbitration management with optimal IDR entity selection, and live tracking via an integrated dashboard. Additionally, the firm specializes in recovering aged receivables from 12 to 36 months old, allowing practices to capture funds previously considered write-offs.
