No Surprises Act · Federal IDR
Kronos RevenueProviders who file federal IDR correctly win 88% of disputes, yet most surgical practices never file.
Kronos Revenue handles every NSA IDR claim end to end. One claim per CPT, specialty coded, quoted to your volume.
New to federal IDR? Start with the filing checklist before you initiate a dispute.
Download the NSA IDR checklistI am a practicing neurosurgeon. I built Kronos Revenue because I watched surgical practices, including mine, lose significant revenue to two specific problems.
The first: most out of network claims that should go to federal IDR never get filed. Each submission takes 30 minutes. Billing teams do not have that time at scale. So the insurer underpayment becomes the accepted rate. The money disappears quietly.
The second: practices that do file are paying attorneys 20% of every recovery. In exchange, most attorneys batch CPT codes, a shortcut that reduces arbitration outcomes and that a 2023 federal court ruling confirmed was contrary to how IDR was designed.
The federal data is not ambiguous. Providers win 88% of properly filed IDR disputes. Median awards come in at approximately 4.5 times the insurer qualifying payment amount. Georgetown CHIR, March 2026. The money is there. The system works when it is used correctly.
Kronos Revenue uses it correctly.
— Dr. John M. Abrahams, MD, Board Certified Neurosurgeon, Founder, Kronos Health
A spine surgery practice recovering $300,000 per year in NSA IDR disputes pays $60,000 annually to a 20% contingency attorney. Over five years: $300,000 in attorney fees. Before counting the disputes the attorney lost from batching CPT codes. Kronos Revenue charges a consultative fee quoted to your volume. Not a percentage of every recovery. Most practices keep roughly nine in ten dollars won at IDR after our fee. Run your own numbers below.
Recovery Calculator
Uses CMS published win rates (88%) and Georgetown CHIR median award benchmarks. Not a Kronos performance claim.
Assumes 88% win rate (CMS Q1/Q2 2025 Public Use File), 3 hrs manual submission vs 15 min with Sydra, $65/hr billing specialist rate. Recovery estimate based on disputed amount midpoints. Not a guarantee of results.
Annual recovery potential
$4.0M
120 cases × 88% win rate × $25K – $50K
Annual cases
120
eligible to file
Hours saved
330 hrs
vs manual
Labor saved
$21K
in billing time
Ready to start recovering?
Get a free NSA IDR review — no commitment.
88%
Provider win rate at federal IDR
CMS Q1/Q2 2025 Public Use File · January 2026
View source87%
of IDR awards exceeded the insurer qualifying payment amount
Same source
View source~4.5x
Median provider award vs. in network rate
Georgetown CHIR · Health Affairs · March 2026
View source$2.2B
Provider IDR recoveries above in network rates through 2024
Brookings Institution · April 2026
View source~10%
Estimated share of eligible claims actually being filed
ACEP analysis of CMS data
View sourceThe most common reason surgical IDR disputes fail is not weak documentation. It is incorrect filing structure.
Federal IDR rules require each CPT code to be filed as a separate dispute.
When an attorney batches CPT 27447 (total knee arthroplasty) with 27369 (injection, knee) into one IDR submission, the arbitrator reviews two procedures with different market rate benchmarks and different qualifying payment amounts. The submission does not map cleanly to any prior determination. Arbitrators resolve that ambiguity against the initiating party.
A 2023 federal court ruling, Texas Medical Association v. HHS, Eastern District of Texas, specifically found that improper batching was forcing providers out of IDR recovery they were legally entitled to pursue.
Kronos Revenue files one claim per CPT. Every time.
You are accepting the insurer initial payment on every out of network claim. For a practice with 15 out of network surgical claims per month, the unfiled gap is likely six figures annually. Kronos Full-Service handles every claim. Zero biller time on IDR.
Get a free IDR review — we show you the number.20% of every award goes to the attorney indefinitely. Plus the cases lost from batching. Kronos Full-Service replaces the contingency model at a lower effective cost per dollar won.
Get a free IDR review — we compare the math against your current arrangement.Your billing team wants to control the workflow and keep all recoveries in house. Sydra is the software platform. Under 5 minutes per claim instead of 30.
See SydraPart of Kronos Health
Kronos Health builds two products from the same specialty trained foundation. Sydra is the software your billing team operates in house. Kronos Revenue is the team that handles every claim when you want zero biller time on IDR. Same CPT depth, different operator.
Scroll horizontally to compare
| Your attorney | Kronos Revenue | |
|---|---|---|
| Fee model | 20% of every recovery | Quoted to your volume — most practices keep roughly nine in ten dollars won |
| Specialty depth | Generalist — IDR is a side practice | Specialty trained: ortho / neuro / spine / plastics |
| Filing approach | Often batches CPT codes | One claim per CPT — the way IDR was designed |
| Who's on the file | Junior associates | RCM specialists trained by Dr. Abrahams (surgeon founder) |
| Communication | Quarterly, if you're lucky | Live 9–5 M–F, 24 hr email, monthly review |
| What you keep per dollar won | About eighty cents — after the 20% contingency | About ninety cents or more — quoted to your volume, not skimmed from every award |
| Total practice savings | 20% fee on fewer won IDR disputes | Greater share of every award — plus more disputes won at IDR |
This is not a sales call. Here is what happens.
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Providers won 88% of federal IDR disputes in the first half of 2025. 87% of award amounts exceeded the insurer qualifying payment amount.
In 2.5 years through 2024, providers recovered more than $2.2 billion from the NSA IDR process relative to applicable in network payment rates.
The median provider win at IDR represents approximately 4.5 times the in network rate.
Sydra reference library: 213+ ingested IDR determinations, over 90% provider wins, weighted toward spine and orthopedic CPT codes. Library statistics describe determinations ingested, not a guarantee of future results.
Free. One business day. We run the math on your actual EOBs. No commitment.
