Full revenue cycle support, built around your practice.
Outsource the whole cycle, or bring us in for the one piece your team needs help with. Either way, every claim is prepared to be paid correctly the first time and followed until it is.
Out-of-Network Reimbursement & IDR Arbitration
When a plan underpays an out-of-network claim, we handle the full dispute: open negotiation, arbitration under the federal No Surprises Act or New Jersey and New York state law, and follow-up until the award is paid.
- Eligibility review: federal IDR, New Jersey or New York arbitration
- Open negotiation notices and payer negotiation
- Deadline tracking from the day the payment or denial arrives
- IDR initiation, entity selection and fee handling
- Offer and supporting-evidence briefs
- Batched disputes for similar claims
- Follow-up until the award is paid
Surgeons, ambulatory surgery centers, emergency and hospital-based groups, and practices with a steady stream of underpaid out-of-network claims.
Federal (No Surprises Act)
Open negotiation lasts 30 business days from the plan's initial payment or denial. If there's no agreement, either side has 4 business days to file for IDR. An independent arbitrator then chooses one side's final offer.
New Jersey
For inadvertent, emergency or urgent out-of-network care by New Jersey providers, the state offers binding arbitration through the Department of Banking and Insurance. The arbitrator chooses between the two final offers.
New York
For emergency services and surprise bills under state-regulated plans, New York's Department of Financial Services runs its own independent dispute resolution process.
- The federal filing fee dropped from $115 to $15 per party per dispute for disputes filed on or after June 11, 2026.
- New batching rules apply to disputes whose open negotiation begins on or after November 1, 2026.
- A new federal IDR Gateway is expected to replace the current portal in late 2026.
- From January 1, 2027, plans must use remittance codes on out-of-network claims that show whether the No Surprises Act applies.
Source: Federal IDR Operations final rules (June 4, 2026) and CMS implementation guidance.
Public federal IDR decisions
What federal IDR has awarded in New York and New Jersey
Federal IDR decisions for common foot & ankle, orthopedic, sports medicine, hand, spine, neurosurgery, pain management and wound care procedures in the New York and New Jersey metro areas, for disputes closed July–December 2025.
| Procedure (CPT) | Decided claim lines | Provider’s offer chosen | Median award when provider’s offer chosen |
|---|---|---|---|
| Ankle fracture repair (outer ankle bone) (27792) | 32 | 97% | $21,285 |
| Ankle fracture repair (both ankle bones) (27814) | 33 | 85% | $32,853 |
| Bunion correction with osteotomy (28296) | 75 | 80% | $33,000 |
| Bunion correction with toe-bone osteotomy (Akin) (28298) | 16 | 94% | Not published by CMS* |
| Lapidus-type bunion correction with joint fusion (28297) | 6 | 83% | Not published by CMS* |
| Bunion correction, double osteotomy (28299) | 59 | 85% | $36,000 |
| Toe joint capsule release (28270) | 9 | 78% | Not published by CMS* |
| Hammertoe correction (28285) | 167 | 90% | $25,955 |
| Achilles tendon repair (27650) | 58 | 84% | $16,000 |
| Ankle ligament repair (27698) | 32 | 97% | $18,075 |
| Ankle arthroscopy with extensive debridement (29898) | 46 | 94% | $14,063 |
| Procedure (CPT) | Decided claim lines | Provider’s offer chosen | Median award when provider’s offer chosen |
|---|---|---|---|
| Knee arthroscopy with meniscectomy (29881) | 273 | 91% | $20,000 |
| Arthroscopic ACL reconstruction (29888) | 216 | 87% | $31,000 |
| Arthroscopic rotator cuff repair (29827) | 311 | 85% | $30,000 |
| Total knee replacement (27447) | 207 | 82% | $50,000 |
| Total hip replacement (27130) | 175 | 87% | $46,354 |
| Procedure (CPT) | Decided claim lines | Provider’s offer chosen | Median award when provider’s offer chosen |
|---|---|---|---|
| Arthroscopic shoulder stabilization (29806) | 90 | 90% | $30,195 |
| Arthroscopic SLAP repair (29807) | 65 | 85% | $30,000 |
| Arthroscopic biceps tenodesis (29828) | 197 | 87% | $28,000 |
| Distal biceps tendon repair (24342) | 42 | 86% | $35,000 |
| Arthroscopic shoulder debridement, extensive (29823) | 273 | 84% | $27,484 |
| Arthroscopic distal clavicle excision (29824) | 214 | 85% | $18,000 |
| Arthroscopic meniscus repair (29882) | 144 | 85% | $20,001 |
| Knee arthroscopy, medial and lateral meniscectomy (29880) | 117 | 90% | $20,555 |
| Knee arthroscopy with microfracture (29879) | 147 | 87% | $24,000 |
| Hip arthroscopy for impingement (29914) | 67 | 84% | $23,000 |
| Hip arthroscopy labral repair (29916) | 41 | 95% | $34,500 |
| Procedure (CPT) | Decided claim lines | Provider’s offer chosen | Median award when provider’s offer chosen |
|---|---|---|---|
| Carpal tunnel release (64721) | 62 | 92% | $11,069 |
| Wrist fracture repair, 3+ fragments (25609) | 60 | 87% | $20,162 |
| Finger extensor tendon repair (26418) | 54 | 91% | $16,500 |
| Trigger finger release (26055) | 43 | 86% | $7,500 |
| Finger flexor tendon repair (26356) | 38 | 84% | $26,610 |
| Procedure (CPT) | Decided claim lines | Provider’s offer chosen | Median award when provider’s offer chosen |
|---|---|---|---|
| Anterior cervical discectomy and fusion (22551) | 651 | 83% | $85,500 |
| Cervical disc replacement (22856) | 128 | 88% | $75,355 |
| Cervical laminectomy (63045) | 111 | 83% | $62,000 |
| Lumbar laminotomy with discectomy (63030) | 389 | 83% | $60,120 |
| Lumbar laminectomy (63047) | 676 | 81% | $77,148 |
| Posterior lumbar fusion (22612) | 348 | 80% | $69,724 |
| Lumbar fusion with interbody fusion (22633) | 330 | 83% | $85,000 |
| Craniotomy for brain tumor removal (61510) | 59 | 80% | $86,000 |
| Procedure (CPT) | Decided claim lines | Provider’s offer chosen | Median award when provider’s offer chosen |
|---|---|---|---|
| Lumbar epidural steroid injection (transforaminal) (64483) | 1,168 | 83% | $13,000 |
| Lumbar epidural steroid injection (interlaminar) (62323) | 310 | 83% | $7,800 |
| Cervical or thoracic epidural steroid injection (62321) | 518 | 86% | $9,350 |
| Lumbar facet joint injection (64493) | 1,063 | 82% | $14,000 |
| Cervical or thoracic facet joint injection (64490) | 690 | 82% | $14,000 |
| Lumbar radiofrequency ablation (64635) | 701 | 86% | $12,750 |
| Cervical or thoracic radiofrequency ablation (64633) | 365 | 87% | $12,312 |
| Sacroiliac joint injection (27096) | 211 | 83% | $8,500 |
| Spinal cord stimulator lead placement (63650) | 47 | 81% | $41,905 |
| Procedure (CPT) | Decided claim lines | Provider’s offer chosen | Median award when provider’s offer chosen |
|---|---|---|---|
| Wound debridement, skin and tissue under the skin (11042) | 105 | 92% | $7,000 |
| Wound debridement down to muscle (11043) | 73 | 88% | $5,500 |
| Wound debridement down to bone (11044) | 70 | 89% | $8,500 |
| Wound bed preparation, trunk, arms or legs (15002) | 268 | 86% | $14,000 |
| Wound bed preparation, face, hands or feet (15004) | 130 | 91% | $7,500 |
| Skin substitute graft, face, hands or feet (15275) | 47 | 89% | $7,682 |
These are public federal IDR outcomes for all providers. They are not MCB Professionals’ results and don’t predict the outcome of any claim. Awards depend on the plan, the service, the documentation and the arbitrator.
Figures are MCB Professionals’ analysis of CMS data. “Median award” is the median out-of-network amount the arbitrator set on claim lines where the provider’s offer was chosen, excluding default decisions and amounts CMS suppressed. Metro areas are the federal regions that include New York or New Jersey.
*CMS doesn’t publish award amounts for procedures with only a few decisions, so no median is shown. With so few decisions, the percentage is less reliable.
Source: Centers for Medicare & Medicaid Services. (2025). Federal IDR Public Use File, 2025 Q3–Q4 [Data file and data dictionary]. Retrieved from cms.gov/nosurprises/policies-and-resources/reports
Medical Coding
Certified coders with experience across all specialties, with particular depth in surgical coding. Accurate, compliant code assignment captures the full value of every encounter and procedure.
- CPT, ICD-10-CM & HCPCS code assignment
- Operative note review for surgical cases
- Coding audits & documentation feedback
- Modifier and bundling review
- Performed under a Business Associate Agreement (BAA)
Practices that code in-house but want a second set of eyes, or that need certified coders for surgical cases.
Medical Billing
End-to-end billing that pursues maximum reimbursement on every in- and out-of-network claim. We actively manage your accounts instead of just watching them.
- Charge entry, claim scrubbing & submission
- Eligibility & benefits verification
- Denial management & appeals
- Payment posting & reconciliation
- Monthly collections & A/R reporting
Practices that want to hand off the whole billing cycle and get clear, regular reporting.
Credentialing
We know each payer's rules, provider credentialing requirements and the hospital affiliation process, so enrollments move quickly and get done right.
- Commercial, Medicare & Medicaid enrollment
- Hospital privileges & affiliations
- CAQH profile setup & maintenance
- Re-credentialing & expiration tracking
New providers, growing groups, new locations and healthcare startups.
Aging A/R Recovery
Aging receivables drain cash flow. We work old claims back to payment, as a stand-alone project or as support for your in-house team.
- A/R analysis & prioritization
- Claim follow-up, rebilling & appeals
- Underpayment identification
- Support for in-house billing teams
Practices with a backlog of unpaid claims, or billing teams that need extra capacity.
Coding & Billing Audits
An independent review of your coding, documentation and claims by certified coders. You see exactly where revenue is being lost or compliance risk is building, with a clear plan to fix it.
- Coding & documentation audits (E/M, surgical and procedural)
- Pre-bill and retrospective claim reviews
- Denial & underpayment trend analysis
- Charge capture & fee schedule review
- Written findings plus education for providers and staff
- Performed under a Business Associate Agreement (BAA)
Practices with rising denials, new providers or coders, an upcoming payer audit, or an in-house team that wants an outside check.
When standard billing isn't enough.
Out-of-network disputes, arbitration and payer contracting take specialized knowledge. These services can be added to any engagement.
Personal Injury Arbitration
Pursuing fair payment on personal injury and third-party liability claims through arbitration.
Electronic Data Interchange
EDI enrollment and setup for electronic claims, remittances (ERA/EFT) and eligibility checks.
Business Development & Payer Contracting
Payer contract negotiation, fee schedule analysis and operational strategy for new and growing practices.
Choose the level of support that fits.
Full-service RCM
We run your revenue cycle end to end, from coding and claims to follow-up, appeals and reporting.
Targeted support
Your team keeps billing. We take on coding, credentialing or the claims that need specialist attention.
Project-based
A defined project such as an A/R clean-up, credentialing a new location or setting up a new practice's revenue cycle.