# IDR Attorney vs IDR Service: The True Cost of 20 Percent
I am a practicing neurosurgeon, and before I founded Kronos Revenue I watched colleagues hand their No Surprises Act disputes to law firms because the firms were the only ones who understood the process. In 2022 that was a reasonable trade. In 2026 the math has changed, and most practices have not rerun it.
The visible cost
The standard arrangement is a contingency fee of 20 percent of every recovery. A spine practice recovering $300,000 a year through IDR pays $60,000 annually. Over five years, $300,000 in fees on a process that has become largely procedural. The fee never steps down. It is 20 percent of the first dollar and 20 percent of the millionth.
The invisible cost: batching
Federal IDR rules require each CPT code to be filed as its own dispute. When a firm batches a total knee arthroplasty with an injection code into one submission, the arbitrator is comparing two procedures against two different benchmark sets, and ambiguity at arbitration resolves against the filer. A 2023 federal ruling, Texas Medical Association v HHS, specifically addressed improper batching forcing providers out of recovery they were entitled to pursue. Firms batch because it is efficient for the firm. It is expensive for you.
The cost nobody audits: the unfiled claims
Contingency economics only justify large claims. An attorney's hour cannot be spent on a $1,500 underpayment, so it never gets filed. Across a year of surgical volume, the small claims a firm declines to file routinely add up to more than the contingency fee itself. The practice pays 20 percent and still leaves money on the table, and that second loss never shows up on any invoice.
What a service model changes
Kronos Revenue charges a consultative fee quoted to your volume, not a percentage of awards. Most practices keep roughly nine in ten dollars won. Every eligible claim gets filed regardless of size, one claim per CPT every time, because our model has no minimum billable hour. The federal data says providers win 88 percent of properly filed disputes with median awards around 4.5 times the in network rate. The wins are there. The question is what you pay for them and which claims ever get the chance.
Run your own numbers
Bring your last 12 months of recoveries to a free review. We show what the same year would have cost under Kronos, including the small claims that were never filed. If your firm comes out ahead, we tell you that, and you will have learned something about your arrangement either way.