Congratulations to the Cohen Howard Surprise Bill team who recently handled a New Jersey Surprise Bill claim for our client, an out-of-network plastic surgeon. Following submission of our arbitration brief, the arbitrator determined our client’s final offer of $60,000 was a more fair and reasonable reimbursement for services rendered rather than the insurance company’s final offer of $7,007.86, while at the same time validating several denied codes.
New Jersey is a baseball arbitration state, which means that the arbitrator chooses one of the parties’ proposals on the disputed claim. The primary purpose and effect of baseball arbitration is to encourage the parties to arrive at a settlement because if the parties fail to compromise during negotiations, the arbitrator chooses the winning proposal, which could result in a grossly low payment to the provider if the arbitration submission is not correctly analyzed and positioned. There is always a delicate balance of how much to propose on behalf of our clients to obtain a favorable result while maximizing payment. Knowing the nuances and sweet spots of your state’s Surprise Bill laws can yield great results in obtaining fair payments. With the new Federal law, No Surprise Act, taking effect in January 2022, the handling of emergency and inadvertent claims will become even more important in revenue cycle management. Cohen Howard maintains a staff of attorneys, medical industry experts and others to assist our clients in management this part of their practice.