No Surprises Act - Outsourcing Versus Software
Post by
Stacey Wright
The No Surprises Act has cumbersome requirements with tight timelines - and the cost of handling it manually is steep. Healthcare Provider executives like you often end up weighing the pros and cons of outsourcing the process entirely, versus keeping it in-house with software to automate large portions.
Full disclosure: we sell No Surprises Act Automation software. But, there are some situations where outsourcing is the correct choice, so we wanted to give you a fair and balanced view of considerations.
Outsourcing
Most of the No Surprises Act vendors on the market are outsource organizations. They take the entire disputes process off your hands - some even include performing collections and suing non-compliant payers.
Admittedly, this sounds pretty appealing, right? The drawback: they mostly charge a percentage of the amount collected. On the one hand, this gives them incentive to do everything within their power to collect (yay!). But, on the other hand, for providers who have a high volume of claims and/or have high dollar amounts to their claims, that dollar amount adds up very quickly and represents yet another revenue leakage.
Let's compare two organizations:
Anesthesia-R-Us is a small organization that has around a dozen No Surprises Act claims a week. Most of the claims are for around $4000.
EmergenciCare is a large emergency services organization with hundreds of No Surprises Act claims a week, totaling approximately $14million in claims weekly.
Each outsourcing organization has a different pricing structure, but for this we will assume both of these healthcare provider organizations chose a very effective, efficient outsourcer that charges a very competitive 20% commission and has an above-average 90% win rate with a remarkable 100% collections success (just to keep the math easy):
Anesthesia-R-Us would end up paying $8,640 a week, or around $449,280 a year. If they don't have a lot of available cash to pay for software implementation up front and don't have the resources to manually manage these claims, the outsourcing option can make sense, at least for a little while.
EmergenciCare, however, would end up paying a crushing $2.52 million a week, building up to over $131 million in commission annually. This is too much revenue leakage; it's a non-starter.
The EmergenciCare organization needs another option.
No Surprises Act Automation Software
For organizations such as EmergenciCare, keeping the process in-house with a high level of automation makes the most sense.
Software such as our No Surprises Act Automation software have a one-time setup cost and a small annual hosting fee - and it does not matter how many claims go through the system or how large they are. The cost does not scale based on usage.
The software sits on top of your existing systems to automate 85% of the overall process, allowing your existing team to handle 5x the volume (or more) they can do manually. Not only that, our customers have seen a remarkably increased win rate of 94% due to improved deadline and IDRE selection management.
For one of our large emergency services customers similar to EmergenciCare, they paid back the cost of setting up the software within weeks of go-live.
Other considerations
While cost is a compelling factor for consideration, there are other risks which may come into play when weighing options:
|
No Surprises Act Automation software |
Outsourcing |
|
|
Increased win rate |
94+% win rate, accurately submitted claims with proper eligibility |
Indiscriminate submissions to state vs. federal causing legal headaches |
|
End-to-end automation |
Complete automation: ONP, IDR, Award Tracking, CMS Complaints Management |
IDR Only |
|
Compliant & Secure |
Single tenant software Environment with HIPAA, HITRUST, BAA, and other industry-specific certifications |
Unknown |
|
Data Control |
Your platform, your data |
3rd party owned |
|
Award Revenue |
Retain 100% of your revenue |
Takes commission for every IDR award |
|
Configurable |
Tailored to fit your needs and quick to modify as changes occur |
Standardized with no competitive advantage |
Conclusion
If your organization has a small volume of No Surprises Act disputes and/or each of those claims is for a small dollar amount, there are plentiful outsourcing vendors who may be your best choice. Tip: be sure to ask about security such as HIPPA compliance and how they handle state vs. federal submissions to mitigate those risks up-front.
However, if you have a high volume of claims and/or if each of these claims is for a high dollar amount, you will get the most total revenue out of scaling your internal team with automation, such as our No Surprises Act Automation software.
Interested in learning more? Book a meeting with Seth, our No Surprises Act Automation expert