Respond to payer pressures before federal fixes arrive: A pro-fee RCM playbook
This spring, the American Medical Association (AMA) and dozens of physician groups sent federal officials a letter detailing how health plans are circumventing the No Surprises Act — through inappropriate cost-shifting, IDR manipulation, depressed QPAs and unpaid awards. For pro-fee groups operating on thin margins, the financial damage cannot wait on federal enforcement.
This whitepaper translates each of the five AMA concerns into a back-end RCM action plan. It details how independent, hospital-based and emergency physician groups can use contract management, payment modeling, denial management, payment posting, payment variance and AR follow-up to recover revenue payers are quietly withholding — without waiting for federal action.
Inside the whitepaper:
This whitepaper translates each of the five AMA concerns into a back-end RCM action plan. It details how independent, hospital-based and emergency physician groups can use contract management, payment modeling, denial management, payment posting, payment variance and AR follow-up to recover revenue payers are quietly withholding — without waiting for federal action.
Inside the whitepaper:
- How to flag and recover cost-shifting through automated payment variance and denial workflows
- What to do when payers misuse IDR reopening guidance to stall payment
- Tactics for pre-screening claim eligibility and tracking payer response patterns
- How to build independent benchmarks to defend against systemic underpayment
Please fill out the form to download the whitepaper.