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Provider and Payer Disputes: Latest Trends and Challenges

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Bob Paskowski, Consulting Principal, PYA, speaks with Mackenzie Wallace, Partner, Thompson Coburn, about the latest trends and challenges facing providers and payers in today’s health care market. They discuss some of the practical recommendations they give clients who are trying to navigate the current landscape, OIG’s April 2022 report addressing Medicare Advantage denials of prior authorization requests, and the impact of the No Surprises Act’s independent dispute resolution process. Sponsored by PYA.

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Speaker 1:

Support for ALA comes from pya. For nearly 40 years, PYA has helped clients find value in the complex challenges related to mergers and acquisitions, clinical integrations, regulatory compliance, business valuations, and fair market value assessments and tax and assurance. PYA is recognized by Modern Healthcare as one of the nation's top 20 healthcare consulting firms, and by inside public accounting as a top 100 accounting firm. Learn more@pyapc.com.

Speaker 2:

Well, hello to our audience. Our topic today is provider and payer dispute. I'd like to let, uh, McKenzie Wallace from Thompson Coburn introduce herself. And then, um, I'll do an introduction and we'll get started. Mackenzie.

Speaker 3:

Thank you, Bob. I'm happy to be here today. As Bob said, we have a lot to talk about regarding provider impair disputes. I am a partner in the Dallas office of Thompson Coburn, and my specialty is healthcare litigation, really any kind of disputes related to healthcare, but specifically the bread and butter of what I do day in, day out is manage care or reimbursement litigation between providers and payers. Uh, sometimes on both sides of the fence, but often on the provider side. And so we are excited to talk about that topic of those disputes and the issues that arise within those and that create those.

Speaker 2:

Great, thanks Mackenzie. And this is Bob. I'm a principal with pya. I lead our managed care practice, uh, nationally. Um, and like McKenzie, you spend most of our time working with from the provider side and anything that intersects with the payers, that could be as simple as strategy. It could be as simple as I've got this contract, I, I need help reviewing or all the way to a support expert witness support in a litigation case or arbitration case. Um, so that's our background. And um, I'd like to just start off McKenzie with, um, just a couple opening thoughts and then we'll get into a question here. But, you know, in general, we know, um, that the current state of healthcare is very dynamic, a lot's going on. Uh, we know from one side of the fence, the providers side, the health systems, the physician groups are facing some pretty significant headwinds and challenges specifically on their expense side of the business. Um, it's been well documented that there's labor challenges, um, both on a clinical and the administrative side supply costs that are really driving the expense side of those, of the, the provider side of our industry. And then you have the payer side, the other side that's, you know, representing the purchasers of the healthcare, trying to keep costs down, and they're not always succumbing to a, a request for a six or 8% rate increase. And so you've got these two, uh, confluences going on between the parties and then layer on legislation. Uh, I think we've had two significant pieces of legislation in the last two years. First, with price transparency in hospitals having to post their, both their charges and their negotiator rates. And now recently July 1st, the payers have posted all their negotiator rates across the country and everyone's reacting to that, that information and trying to, to process that. And there's a lot of administrative burden with putting, putting all that data on in, on the, on the, on the network. So given that backdrop, Mackenzie, what do you, I I'd just like to hear your thoughts about some of those topics and maybe how your, your side of the practice is starting to react to those.

Speaker 3:

Absolutely. I mean, I think you kind of put it all in a nutshell, really well, Bob, that it is a, a challenging system right now and it is certainly dynamic. I I recently sat in on a panel, uh, that included, uh, federal legislators and business and, uh, the hospital side and the pharma side. And there was a lot of discussion, of course, about inflation and about the cost of healthcare and the burden of consumers, which we all are. Uh, there was not a lot of discussion about this particular issue, which is provider and payer issues and how it impacts, uh, that really intersection of, of, of cost and value and inflation and all of that. And I think some of the things we're gonna dig into today in more detail will really start to shed some light on ways in which, uh, providers and payers, uh, can create solutions to lessen some of the concerns that are occurring and ways in which providers and payers are already pursuing those solutions in court to try to get some resolution as to meaning and understanding of certain pieces of the no surprises act. And, and so just to touch on that a little bit more in depth to start out, um, what we, what we do on the day to day is, is of course, representing, um, providers and sometimes payers, uh, in their disputes regarding under payments or denials of, of large aggregate claims. And so what we often see at both a granular level and then when we jump out to the 30,000 foot view, is really what is preventing, um, payers from paying or providers from getting paid, and what is increasing heavily increasing the administrative burden that further drives that cost up for all of the parties involved. And, um, we are gonna talk more today about, um, the OIGs kind of dig into this. We're gonna talk about the no surprises act. Um, you know, there its impact on all of this, both, both at the state and the federal level. Uh, but certainly, um, I think what's not often part of the act of discussion is how the disputes between these players really are very indicative of how the system is both succeeding and failing, and certainly all of the parties involved can learn lessons and, and have takeaways on how that can be improved to their benefit. So, Bob, as it relates to that, in light of the, of the current landscape and in your everyday practice, uh, what type of issues are, are you seeing and how are you recommending from a practical standpoint, uh, that your clients resolve some of those issues?

Speaker 2:

Right. Uh, I would say the first thing, but they tend to focus in on is the net revenue. So we talked earlier about the expense side of the business, all the, the headwinds on that. So a lot of their focus is moved to the net revenue side. And I'll characterize it in, in one kind of simple statement, then we can dig into it. But the first statement is, I've got a contract between myself and a pair, and I'm gonna provide this service, and I'll keep it simple. I should get paid a dollar. And what we're hearing from, from providers, uh, across the country is that I'm not always getting the dollar. We have this agreement that we're supposed to get the dollar and, and we all know there's hosts of reasons of why we're not collecting the dollar. And it could be, you know, anywhere from it wasn't authorized, um, it got down coded, it was the right side of service, et cetera. But at the end of the day, they, they feel like they've got a contract that's earning a dollar on that particular case. So we're really focusing on those, that net revenue realization side of that. Again, how much of that dollar should we be getting? And, and you, you pointed out something earlier about the administrative burn of this, and we're talking thousands and, you know, millions of claims are getting processed daily. And again, every one of those that don't hit that mark creates an opportunity to at least understand that difference. So, so th those are, that's been kind of the focus. And on that, the, on the net revenue side, and I'll also add to that, that there's been a, uh, with that administrative burden, um, we've had to provide actually some, some horsepower to help that. Um, again, it's very intense. There's a lot of information to, to gather, and what we try to do is bucket them. So here's a set of claims that historically has not been processing according to what we believe is the contract. And it, there's been some times even shortage of, uh, this kind of skill within some of the provider systems. So we've been able to help fill that gap from a capacity standpoint and sit in that chair with them, but also almost like an Overwatch program on their net revenue as well. And we tr we tend to, to jump in and look at bifurcate that into two pieces. Am I getting the dollar, which is what we would call the, the realization side of that. The other side is, should I be getting a dollar 25 in that, what we find a lot of times it's, um, that there's not, that a lot of the priors aren't keeping up with their contracts and trying to earn additional, um, dollars through their contracts.

Speaker 3:

If you dig into that analysis from a big picture standpoint, what reasons are emerging as to why providers aren't getting that dollar? And you know, arguably if we're staying objective on both sides of the fence, why are payers not providing that dollar or paying that dollar?

Speaker 2:

Yeah. And, and I think the burn of proof is on both sides. And what we find in a lot of cases, it could be the provider side. So the, the revenue cycle isn't constructed correctly where they're not billing the right codes or they're just some of those, I'll say more technical issues of not providing that. Um, in a lot of cases they may not be presenting the authorization, um, that, that that particular service that's gonna be provided tomorrow needs an authorization. Uh, so following some of those, I'll say pre-service rules, um, again, checking eligibility and all that, um, could also provide, you know, reasons why on the provider side, the, that, that they have the burden to make sure all that preservice, uh, at the point of service is all, all ready to go and being submitted correctly to the, to the provider or to the payer. And then the payer provides all, it's its rules. Um, it's in, you know, site of service. The code may not, um, meet the medical necessity needs. Um, in a lot of cases, um, payers will ask for documentation on specific, on larger claims, or they want to assess whether it was the right care setting. A classic example as you know, is, is this inpatient or should it be observation? I mean, huge difference in that, that difference. And you know, this McKenzie, we could put a a hundred different clinicians review the same medical record, and they're all, they could potentially all have different angles and different responses. So it's not real objective either, but, so you've really gotta balance both sides of this, that at the end of the day, you gotta meet all the needs from the provider and submitting the claim and the documentation, and then the payer has to look at their own protocols and make sure we've gotta match. And then that dollar is paid. Unfortunately, we don't see it happening enough,

Speaker 3:

We don't see it happening enough. What do you mean, Bob? That, that the providers and payers aren't digging it, digging into it at that level or,

Speaker 2:

Well, again, back to our realization rate, you know, how many times are we getting the dollar? It's those, those percentages that are coming below that. And then it takes, it takes horsepower research to come up with that and submit the right information and to continually pursue that. There are cases where, you know, after all that work, um, sometimes the providers get to a point, like, I, I've done everything I can do, I can either write this off and move on to the next one, or, you know, I pursue further action pursuant to your, your agreement and, and try to move things in a different direction.

Speaker 3:

I think that's, that's exactly right. Bob and I, I want you to dig in on what exactly you provide as far as, um, when, when a client reaches out to you on that end. But I think from our perspective on the, when it gets to litigation side, oftentimes it's already heavily escalated and more often lately, uh, clients have been bringing us in to assist with an early resolution before things get as heated, um, as they sometimes get where someone ends up actually filing suit or arbitration, whichever it is, depending on whether, um, the, the agreement requires one or the other. But as it relates to the underlying dispute, a lot of times clients aren't bucketing or understanding from that net revenue perspective, what are the issues that we're facing in large amounts of claims and how can we categorize those in issues and determine what are likely to succeed if we attempt a resolution, a sit down, a mediation, a negotiation with the opposite side, uh, via maybe a joint operating committee meeting or just engagement between business offices or potentially engagement between council, where councils in the background at first just helping to resolve from a legal perspective or a consultants in the background helping to identify those issues. But as kind of a big picture issue first on the revenue cycle management side, first you have to identify what are the big picture issues that you're seeing, what's emerging as your problem areas on either side of the fence payer provider, and how can we potentially resolve those so that the process goes more smoothly? And some of that's some backend education as well. You know, a lot of the takeaways from the type of work that you and I do, Bob, is to say, Okay, on the back end, we've seen this problem occur multiple times. How do we resolve this before it escalates to this problem again? And is it something that we are doing or is it perhaps some kind of abusive procedure that's happening that's out of our control that we just need to be canned and ready to deal with when it presents itself?

Speaker 2:

Correct. And, and part of our work is usually that assessment of, again, if my car's not driving right, I don't know, it's the carburetor, I've gotta take it in and get, run some diagnostics on it to figure it out. No different here with, again, if I'm only getting 85 cents on a dollar, let's do some, some diagnostic reviews. And again, a lot of times we'll come to them and say, here's a top 10 list. If I'm sitting in your chair, these would be the 10 things I would do first. And you, you hit the right point of we can't boil the ocean here. We can't fix every claim. But there are, there are larger payers, um, larger dollars all kind of focusing, Hey, it looks like it's this code or it's this site of service or something that starts to forensically tell us something's astray here. Let's dig into that and that, and then it's appropriate to, to set up those, and we've participate in those Joe operating agreements, uh, um, meetings with the payers, and we sit down and we go through claims like, like claims to say, this we think is a, is, um, systemic issue and we've, we, this is what we're seeing. And again, having that dialogue, that's unfortunately, that's the only way you can really get to that. Um, because it's really hard through try and go through email and, and limited amount of claims that you can review over the member services calls. So it's those meetings that are, are, are trying to resolve those big issues. Again, not trying to bo below the ocean there.

Speaker 3:

Right. And I would back up and say that it can, that value can be at any stage of the process, but it could be engaging someone to assist you with identifying where your problem areas are. It could be, you know, going forward once you know what those are, or it could be at the most escalated level pursuing those once, you know, you can't resolve those through some kind of friendly means. So I I agree. That's totally, uh, invaluable. Um, what about the, the OIG report? Bob, let's jump into that. Tell us a little bit about that and then we will dig into that from there.

Speaker 2:

Right, and, and again, it just, I, I think it highlights again, a little bit of what we've already been talking about, um, albeit a small sample, um, of, you know, a a week's worth of claims across several of the large, um, managed, uh, Medicare advantage organizations that the OIG report included. But you know, as, as we look at some of those denial rates both on the authorization side and the payment side makes you pause and think like, wow, that, that those denial rates to me, um, kind of raised some concerns. Uh, those are,

Speaker 3:

Let's, let's back up. First we're talking about the OIG report that was issued in April of 2022 mm-hmm.<affirmative>, and it specifically addressed Medicare Advantage denials of prior authorization requests and raised concerns really about beneficiary access to medically necessary care. And it dug into the OIG has dug into, uh, why those claims aren't being paid. And so that's what you're referring to is that that report has now concluded that some of this relates to kind of two bigger categories. Is that fair?

Speaker 2:

Right. It would be the authorization side of that, you know, on a pre-service perspective, and then also from the payment side. And, and some of those rates, um, I believe is 18 and 13% respectively, um, you know, are a little bit higher than you would typically see in the industry for, for, I'll say from a denial rate perspective. Um, and again, the report does<laugh>, What's

Speaker 3:

That? I would argue it's pretty representative of the industry. Yeah. Um, at least, I mean, and, and it was from a, a, a stratified or a random sample of a, a certain subset, right? And ultimately the study found that 13% of prior authorization denials met Medicare coverage rules, even though they were denied. And that 18% of the payment denials met Medicare coverage billing rules, but they were denied. And so what we're basically saying in reading that reporter understanding from that report is pretty commen through with what I'm seeing in practices. Certainly there is a percentage of claims where providers are getting it wrong and are making mistakes, and those mistakes kind of go down the path of the appeal. And there are different legal arguments for how to pursue those claims even when the mistakes are made. But there's also a certain percentage of claims where no mistake was made, and these claims are still not being paid properly because a different rubric is being applied than what is legally required. And that is really relevant to the underlying dispute because when that occurs, it increases heavily the administrative burden for the providers to get paid. And the end result is the fight that really led to the nsa, which is consumers are paying too much, What do we do about this? Consumers premiums are absurd. What do we do about this? Consumers are being balanced filled without being told. And a lot of that relates to underlying issues and, and the policies, uh, that occur and that are applied, uh, resulting in un underpaid or unpaid claims where providers have already, uh, provided those services.

Speaker 2:

Right. And then that gets into the whole issue of, okay, how do I, what's my recourse to, to reverse those, those denials? And I think the report also mentioned that several of those did get reversed, but sometimes that could take months a year of, again, a lot of adminis, a lot of administrative burden in and filing documentation and back and forth and filing, getting payment. Um, you know, meanwhile, you know, that could be 12, 18 months after that data service. So it, it's, it's a grind certainly. Um, just was curious how, how your practice is reacting to that report as well. Um, just be seeing how, how your clients are

Speaker 3:

Reacting. The report. The report, like I said, is unfortunately commensurate with what we see in our day to day. Uh, I think more than anything, what's surprises me so often is that providers don't understand, always understand some really well oiled large providers really understand how to resolve these issues, but, um, some don't and aren't, and so they don't realize that there is an avenue for relief even after, um, they don't have to write off significant portions of bad debt where there is a possibility to pursue that in litigation. And, and likewise on the payer side, when we represented payers as well, which is less, but, but sometimes, um, where, you know, the, the resolution cannot be reached. Um, the payers do not just have to turn over and pay, and certainly in most instances they don't. Um, the best case scenario is when we don't have to do any of that and when we can, uh, facilitate great resolution pre any kind of formal litigation, right? And that does happen. That truly does happen, and that is a huge value add to every party in the process. And, um, let's kind of shift now into the no surprises act, because that really touches on that process, right? That that more formal process and how it's impacted litigation. And it really started, uh, as a Texan, it started for us earlier than the, the federal started, right? Because many states, including New York and Texas and some of the other bigger areas have and had earlier, even before the NSA was, was passed state versions of the No Surprises Act. Um, obviously the piece of that that is super relevant to this discussion today is the piece about the IDR process between providers and payers, but certainly there's the consumer facing piece of it as well, Bob, which we can touch on, um, that we may not have the time today. So in your experience, Bob, how is the IDR process expanded what you're doing and how you're able to interact in these payer provider disputes?

Speaker 2:

It, it's become sort of the wild, wild west a little bit because think of the never in my career have now all this information flooded the market. So, you know, what's this qpa mean? Um, what does in network mean? What are ghost rates? All these, these new, I don't wanna say not new terms, but just new concepts of how are we trying to, to manage this? So even though the IDR process kind of mostly addresses out of network rates, um, we're actually involved quite a bit within network providers who are facing going on a network. So you've got both sides of that and what we're calling offense or defense, and the way we try to depict it for clients is think of a bar and there's a bar, and this is the, the in-network rate, um, as defined under the no surprise act. And then as the, the qpa, there's this bar and it's the median average or the median rate, um, across same service, same geographic region. So let, for example, let's just say it's, um, radiology and it's radiology in Texas and you're in Dallas. And so accumulating all those in-network rates is what the payer's supposed to compute. The, the, uh, qualifying payment amount, it sets the bar, the in-network bar, and it's the median. So there could be, let's say there's a hundred practices in the Dallas region, so that, as far as that bar goes, there's obviously groups that are above the bar and then there's groups below the bar. If you're the provider and you're above the bar, you're probably not saying much, right? You're just sitting there, you know, billing claim, uh, you know, billing services and getting paid. Um, and then if you're below the bar, like, no, I want to be above the bar, or at least to the bar. And so we've, we've been advising on both sides, and let's just play, let's do the offense side. The offense side would be, I'm, I, I'm out at network with a couple payers and they're paying me these lows rates and we all, we, we, we know about the usual and customary rate, which is this artificial numbers that, that the payers come up with, and they're setting that, that that rate and paying that rate and, and the provider believes they're below the bar. And the, one of the things we first try to figure out is where's the bar? And, and I'm telling you that's not a straight bar. It's a blurry bar right now, and we're trying to figure that out.

Speaker 3:

I would argue, Bob, that the bar is in the improper place, right? That's, that's what is being and has been litigated when, when Bob refers to the qpa, he's referring to the qualified payment amount. And, and arguably providers and provider associations have sued in various courts to, to make the point that setting the bar at the qpa and nerves to the benefit of the insurers, that the qpa is generally the median of the contracted rates. And when you're talking about out of network providers, uh, their, the contracted rate, uh, according to a lot of market experts is not, uh, the only factor that should be included because they can't suffice, right? If they are in a rural area and they have a large amount of uninsured or underinsured, uh, patients that are coming through the door, if when out of network people come in, they get the contract rate or below contract rate, they're not getting the benefit that most people receive that most providers receive from the elective care when you're receiving those end network, uh, elective services as part of being a contracted provider. Uh, and so it's hard to meet your bottom line. It's not impossible, and that is driving providers out of, out of the space. And when hospitals are closing in those areas, then it only exacerbates the issue that much more. And so successfully, uh, at least in one case, again, in my home state of Texas, uh, in the eastern District of Texas, a judge has ruled or held that the CMS rules regarding the NSA do run afoul of the administrative procedures act. And that that setting of the qpa at the median of the contracted rates is, is not a, a valid, uh, rule. And so we'll see how that continues to play out in litigation. It'll be very interesting to see how that impacts the NSA over the long term.

Speaker 2:

Yeah. The other thing we're two, we're sharing also with, with provider clients, Mackenzie is the network adequacy rules. So a lot of these, although they're, you know, it does not include Medicare advantage plans, the, the federal IDR process, but with some of the state Medicaid plans, um, if they go outta network and you know, they're suddenly having economic burdens and now I, I can't cover, you know, the OR time like I used to, and people are losing access. Uh, if you go out in network, sometimes that will trigger a network adequacy deficiency, um, on the Medicaid programs. It's just not, it's not good for patients, It's not good for our US as consumers. So, you know, every, every action has a consequence to it. So, you know, I understand the payer's perspective of trying to get rates that they believe are, are too high down, but by the same token, there may be a very solid reason, which goes to the IDR entity that talks about other things beyond just a number, wherever that bar is. Um, whether that's, you know, a certain specialty that is hard to recruit in a very rural area, if, if they, if they pack up and go home, what happens to those patients in that marketplace? So there's all those patient issues and access that's also gonna be eventually flushing out with this. Um, but again, back to that, that bar point, if, if you're below that bar, you've got the opportunity to try to elevate that number and perhaps go all the way through the IDR process, which we have represented clients to do that, and to at least get little, little clarity around where, where the payer is on those, on those qualifying payment amounts, so you understand maybe the next time it happens or you've got another payer, hey, here's sort of where we're starting to see where that bar is. And, and, and you as a provider need to make a very strategic decision about do I run this process? And, and it's, it's probably takes between 90 and 120 days from that data service to get resolution again, another delay in in potential payments. So it's weighing, it's weighing all those options.

Speaker 3:

It's really resulting in very heated contract negotiations because I think payers are using the qpa to argue that these rates need to go lower and lower for some too. And so that is lengthening, I think the heated disputes that are occurring. I know there's some hot button disputes being publicized in, in certain markets all over right now. And, and so certainly that's front of mind on the front end as well. And, and it's interesting because even though what both of what Bob and I do certainly relates to the back end fight, a lot of the time I find more and more, um, that our large healthcare group and our firm is, is calling upon me at times to weigh in on early issues before we ever get there, right? That weigh in on this managed care contract, what happens when this goes wrong, and, and give context, not just from the perspective of, you know, the, the transactional focus that you would expect goes into building these contracts or negotiating these rates or looking at it on the back end, but focusing on it before we ever get to the fight based on the experience of having gone through the multitude of fights that we've seen. So that's an interesting extra layer that I think providers are weaving in, uh, which is wise and and useful. Um, Bob, I I think we've got time for maybe one last question. Uh, what, what is maybe the, the biggest issue or biggest request that you're addressing as it relates to provider payer disputes currently?

Speaker 2:

Hmm. It's hard, hard to get it down to one. Um, and I would say again, the emerging topic right now is around this, um, the IDR and the out network, uh, issues. Um, it's, it's been, you know, written about in modern healthcare about the volume of cases going on at that, those statistics blew me away when I read that, where there was some like 46,000 IDR cases filed in this country. Um, and we're here only here in September. Um, and it's the, it's, and it's the combination of that with the fact that all this payer data is, that was just released in July. So you've got all this data kind of starting to become transparent, which is, you know, purposeful. And then how are people trying to react to all that data and where do I stand from a, from a contracting perspective, again, keeping in mind what we talked earlier about trying to get the, the right amount of net revenue to run my business, provide high quality service, and as that gets diluted, I've gotta fight and I've gotta make sure I I I'm, I'm earning the dollars we deserve that they deserve. And so it, it's really that combination of the, the, the impact of the, the NSA and the idr because the, the folks that are sitting at the high end of that bar, they're getting sometimes termination notices and, you know, how do we fight that? And a lot of times those are 60 or 90 day termination clauses and we're all trying to figure out all that, you know, at the end of the day, we're trying to keep all providers in network, you know, that's good for patient care, uh, at rates that are economical that can keep, you know, the ongoing, um, uh, financials of those particular organizations. Um, and if you're, you know, below, below that bar, we're trying to get folks to, you know, consider trying to figure out how to, how they get those rates. And now they've got a, they've got a mechanism to do that. Um, and frankly, they've lost some revenue there with the note surprise that cuz in a lot of these hospital based providers, they're, they're not permitted anymore to per a bill above usual and customary. And so that loss revenue, they're, they're trying to think about using the IDR as a, as a tool to, to, to get those, uh, additional dollars from the rate side. So, so I'll flip it back to you maybe to close here. Mackenzie, what's your number one issue you're dealing with on payer, payer and provider disputes?

Speaker 3:

Yeah, so I think I'm seeing most often involvement in, in two ways. Number one, on the front end, I think more providers are engaging, uh, council and others to assist with how do we not end up where we were, How do we create early fixes, either contractually or through other means to resolve these before they get these massive sets of under payments and, and denials. Okay. So that's kind of one bucket. I would say the other bucket is where that just isn't possible and then it obviously result results in it in a busy docket for us, which is, which is good but bad on, on the, on the consumer side, that's bad. And so from our perspective then within that bucket of fights, what I'm most often seeing is a percentage of mistakes by the providers that are not excused. A percentage of mistakes that led to the underpayment or the denial by the payers. Uh, and then a certain amount of, a smaller amount of true disputes that exist, right, of true disputed claims where it's not clear, it's, it's gray and there needs to be someone, an arbiter or a judge to weigh in on, on who should get paid or who should not get paid as a result of those disputed issues. Um, but certainly where we're talking about, again, on the back end, those disputes by the provider or the dis those disputes by the payer, those are the easy grabs, right? That's the way that if you involve us in that front end bucket, if you involve someone in that front end bucket, then you can certainly, um, immediately add value to the bottom line, which is an amazing thing to do as a litigator. We are so often a cost center and in this case we're really a value add. And, and that's exciting to be able to put money back in the pockets of providers into add, add that that value before the cost of doing so is really, um, a bigger cost. So

Speaker 2:

Yeah, and I don't know if you find this as well and that if, if they, they being either payer or the provider engages you or I, from a legal or business perspective, that also sends a message back to the other side, like, we want to resolve this. We're, we're spending our own dollars to try to get these resolved, you know, pre-lit litigation, pre arbitration, and a lot of times we get a pretty favorable reaction, uh, from that. Um, versus just trying to, you know, make calls into the call center and resolve it, you know, one claim at a time. So, um, hopefully when we're we're engaged, those are, we're moving it forward in the right direction. But you're right, at some point it's, you know, when things kind of hit that, that wall and you've gotta go a different direction. So.

Speaker 3:

Well, it was a pleasure to talk with you about this today,

Speaker 2:

Bob. Yes, McKenzie, we could talk hours about this and appreciate um, spending some time with you on this and um, I hope our audience has enjoyed this and have a great rest of the day, Mackenzie.

Speaker 3:

You too. Thanks Bob.

Speaker 1:

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