Healthcare Revenue Recovery
Healthcare revenue recovery is the pursuit of payment owed to healthcare providers and facilities under federal and state law. It covers underpaid, delayed, and denied claims resolved through arbitration, appeal, or litigation.
As a healthcare provider, your time goes to patients. As a facility, it goes to running the operations that support patient care. Chasing an underpaid or denied claim competes with both. Most practices don’t have staff whose job is fighting a payer through months of appeals. Because of that, Kelley Kronenberg’s healthcare revenue recovery attorneys take the work on directly.
Our team handles four areas of recovery:
This work sits within our broader health law practice, which also handles regulatory compliance and licensing matters for providers.
Federal No Surprises Act (IDR) Recovery
The federal No Surprises Act applies nationwide. It created a structured process for out-of-network providers to resolve payment disputes. That includes emergency services, non-emergency services performed at in-network facilities, and air ambulance transport.
When a claim does not resolve through open negotiations, it moves to the federal Independent Dispute Resolution process. That process gives providers a defined path to a fair payment determination. Even so, the process runs on tight deadlines and technical filing requirements. A missed step can cost a provider the claim entirely. For more information on these rules, see CMS: No Surprises Act IDR Process.
Kelley Kronenberg prepares the initial submission and gathers documentation to support a fair payment offer. From there, our team negotiates with the payer before arbitration becomes necessary. Still, a favorable determination doesn’t always result in prompt payment. When that happens, enforcement is what turns a win on paper into money in the practice’s account.
Florida IDR Process under Section 408.7057
Florida also operates its own state-level resolution program under Florida Statutes Section 408.7057. When a claim meets Florida’s jurisdictional thresholds, the process runs similarly to the federal IDR program. In addition, providers can often aggregate claims to meet those thresholds. Since filing under the wrong track costs months waiting to be directed, our team focuses first on confirming the right avenue of pursuit.
Florida In-Network Claim Recovery
In-network status does not guarantee a claim is paid correctly or on time. Disputes over coding, administrative processing, authorization, and/or medical necessity can cause underpayment or improper denials. This can also occur when there is a gap between the managed care agreement and how the payer processed the claim. Either way, it’s money the practice has earned and hasn’t received. These disputes involve complex business relationships and can require litigation or arbitration to fully be resolved.
Florida Out-of-Network Emergency Services Recovery
Providers are entitled to proper payment for emergency services rendered out-of-network. Florida law determines that proper payment includes the provider charges, an agreed amount, or the usual and customary provider charges for similar services within the community. Even so, insurers oftentimes deny or underpay these emergency services claims. When that happens, Kelley Kronenberg’s team pursues proper payment through litigation if a payer won’t honor what the statute requires.
Why Choose Kelley Kronenberg’s Healthcare Revenue Recovery Team
Every payment dispute runs on its own deadlines, its own statute, and its own process, whether federal or Florida. Getting the process wrong can be very costly to providers. Our team tracks each claim through the correct process from the start, regardless of claim size or complexity.
Healthcare Revenue Recovery FAQs
Healthcare revenue recovery is the legal pursuit of payment owed to providers and facilities for services already rendered, typically involving claims a payer underpaid, delayed, or denied. Kelley Kronenberg handles this work at both the federal and Florida state level.
It is federal law, so it applies to providers nationwide, not just in Florida. Florida also has its own state-level process for claims that meet certain thresholds, and Kelley Kronenberg confirms the right track before filing.
Claims typically qualify when they involve out-of-network emergency services, non-emergency services at an in-network facility, or air ambulance transport, and when the open negotiation period has already passed without resolution.
Federal IDR applies to claims governed by the No Surprises Act. Florida’s IDR process applies when a claim meets the state’s jurisdictional thresholds and involves state-regulated insurance. Choosing the wrong track can delay recovery, which is why Kelley Kronenberg confirms it before filing.
Not necessarily. Recovery windows are often longer than providers expect, and providers can sometimes pursue claims in batches. Kelley Kronenberg can review the details and give a direct answer on whether it is still recoverable.
Pursuing a claim through the proper statutory or contractual process is routine in healthcare billing, not an adversarial act. It does not require a provider to give up a claim it is legally owed.
Our healthcare revenue recovery division takes on individual claims as well as larger volumes of underpaid or denied billing. Florida’s IDR process also allows claims to be aggregated, which can make a small claim worth pursuing once it is combined with others.
Locations We Serve
- Florida
