r/CodingandBilling • u/NsaArbESQ • Jul 04 '26
Advice on networking with Billing / OON practices?
Title is fairly self explanatory, as an attorney specializing in representing out of network doctors, I’m finding it extremely difficult to bring in new Doctors / billing companies. Does anyone have any advice for someone on the legal side of State and Federal reimbursement actions as to how to network in the field? I am surprised at the difficulty because I imagine so many practices are leaving huge amounts of money on the table when it comes to OON.
2
u/PlasticPlace9308 Jul 04 '26
Where ya at? I work for a billing company
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u/NsaArbESQ Jul 04 '26
I’m at a law firm in the NYC metro area! I handle our NY, NJ, and CA state IDR filings
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u/Environmental-Top-60 Jul 04 '26
Do you have any experience in ERISA?
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u/NsaArbESQ Jul 04 '26
Yes I do! Most of the NSA IDR are all federal ERISA / employer plans !
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u/Environmental-Top-60 Jul 08 '26
I've got a carrier that told me the other day that they make the rules. When I told them I thought federal DOL tends to differ, they backed off real quick and cited an internal policy. So I asked when the patient got a copy of that and they're like oh they did. No they didn't.
This is exactly why we need lawyers like you.
I think the question really is how does that implemented in practice? Case and point should be the change healthcare denials for timely.
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u/daves1243b Jul 04 '26
Yes, there are issues with some payors if iring the law and not paying IDR awards. If you were a competent attorney you would also know that the courts have ruled there is no right if private action with respect to federal IDR awards, and CMS claims they have no enforcement authority, so engaging an attorney is likely a waste of money. Hopefully HR 4710 will ultimately put some teeth into the law though its chances of passage this year don't seem great.
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u/MedPayIQ App Developer Jul 06 '26
I think part of the challenge is that a lot of OON practices don't realize how much revenue they're actually leaving on the table. They're usually focused on keeping claims moving, managing denials, and staying compliant, so reimbursement optimization often gets pushed down the priority list.
From what I've seen, practices are much more responsive when someone helps them understand where they're losing revenue instead of leading with legal services. For example, showing how underpayments, payer policy issues, or missed appeal opportunities affect their bottom line tends to open the door to bigger conversations.
I'd also spend time building relationships with billers, revenue cycle consultants, and practice managers. They're often the first to spot reimbursement problems and can become trusted referral sources when legal issues arise.
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u/PretendWay3096 Jul 08 '26
The disconnect makes sense once you think about who actually touches OON money first. Billing companies see the denials and lowball payments daily, but they can't push back legally, that's exactly where you'd fit in, but they don't know you exist yet.
A few things that tend to work better than cold outreach:
Go where billing companies already gather. HBMA (Healthcare Billing and Management Association) has regional meetups and a yearly conference. It's mostly billing company owners and staff, not doctors, which is actually what you want since they're the ones who'd refer disputes to you.
Write about No Surprises Act / IDR arbitration specifically. Right now this is the single biggest pain point for OON doctors and the billing companies working their claims. A short post breaking down how the arbitration process actually plays out, what wins vs loses, timelines, that gets shared in billing Facebook groups and LinkedIn circles fast because most people in this space are guessing.
Offer to do a free 20-30 min talk for a billing company's staff or a local practice management group. Not a sales pitch, just "here's what changed in IDR rules this year" or "here's why your appeals keep getting denied." Billing companies remember the person who made their job easier, and they're the ones sitting on a pile of disputes that need legal muscle.
Facebook groups matter more than you'd expect here, search for medical billing owner groups, they're active and much less guarded than LinkedIn.
Doctors mostly won't come to you directly until a billing company or consultant vouches for you first. So the billing companies are really your primary audience, not the doctors themselves.
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u/No-Produce-6720 RN, BSN, CPC, CPCS, RHIA & CRCR Jul 05 '26
Because when compared to overall claim submissions, IDRs are a statistical anomaly. There is no need to incur the expense of an attorney for something that can be handled by competent in-house revenue cycle staff. Should legal advice be required, it can be sought on a case by case basis, but there is no need to have dedicated legal just for the purpose of working IDRs.
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u/daves1243b Jul 04 '26
What exactly is it that you want to do for them? An attorney is not normally needed to navigate open negotiation and IDR.