Episode 4: Jennifer Brown

Episode Description:In this episode of The Strain, Jennifer Brown, General Counsel at Progressive Emergency Physicians, joins hosts Eliot Listman and Jim Blakeman to delve into the complexities of healthcare litigation and revenue recovery through the lens of the No Surprises Act. Jennifer shares insights into navigating the Independent Dispute Resolution (IDR) process under the NSA, securing in-network contracts, and managing payer disputes. The discussion covers key strategies for tackling payment denials and balancing payer relationships. Jennifer also offers insight into the intricacies of batching claims efficiently for IDR.Timestamped Overview:00:00 – Introduction01:07 – Host and guest introductions: Eliot Listman introduces co-host Jim Blakeman and Jennifer Brown, General Counsel at Progressive Emergency Physicians. Jim describes his travels throughout Europe.02:10 – No Surprises Act (NSA): Discussion on the NSA and challenges with the IDR process.04:26 – Background on Progressive Emergency Physicians and its in-network strategy.05:24 – Jennifer shares her experience balancing legal responsibilities with revenue cycle management after the NSA's introduction.06:30 – Success with signing contracts using IDR: Jennifer attributes wins to her deep understanding of the regulations.07:49 – Handling payer pushback: Negotiating reimbursement rates and resolving contract disputes.09:03 – Dealing with denials and audits: "At the end of the day, it requires a ton of babysitting from your revenue cycle management partner."10:00 – Tackling out-of-network claims through the IDR process.11:03 – The impact of IDR success on payers' willingness to contract: "You must’ve built a pretty good plane to yield these guys willing to contract."12:15 – Importance of transparent communication with hospital partners to maintain contracts.13:19 – Jennifer’s key strategy: "Over-communicate, can’t go wrong. Persistence is key. Communication is key."15:30 – Challenges with batching claims: Navigating complex rules across states like New York.17:30 – Learning through trial and error: "It’s trial and error. If the IDRE says these claims are improperly batched, you resubmit them."20:30 – Practical tips to get payers to pay post-IDR wins: "More organized you are, the quicker you’re going to get paid."23:00 – Discussion on pending regulations and legislation to improve IDR compliance.25:05 – Overview of the Texas Medical Association (TMA) cases challenging the NSA’s payment methodologies.28:30 – Challenges with insurance-driven methodologies like the Qualifying Payment Amount (QPA).30:12 – Payers’ lobbying influence on policy and the reality of insurance premium increases.32:15 – Litigation trends: The significance of recent legal decisions on the IDR process.34:30 – Jennifer discusses her work with EDPMA to address issues plaguing the No Surprises Act.36:37 – Closing remarksThe Strain is sponsored by Allia Group: Financing Healthcare LitigationConnect with Us!Connect with EliotConnect with JimConnect with Jennifer BrownFollow Allia Group on LinkedInVisit Allia Group Hosted on Acast. See acast.com/privacy for more information.